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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

27卷

期数:

2021年04期

页码:

369-373

栏目:

临床医学

出版日期:

2021-07-20

文章信息/Info

Title:

Correlation between delphian lymph node and cervical lymph node metastasis of papillary thyroid carcinoma

文章编号:

1006－8147（2021）04-0369-05

作者:

闫云飞¹; 刘娜¹; 叶贝贝¹; 杨蓉¹; 2; 张文超¹; 王旭东¹

（1.天津医科大学肿瘤医院颌面耳鼻喉肿瘤科，国家肿瘤临床医学研究中心，天津市“肿瘤防治”重点实验室，天津市恶性肿瘤临床医学研究中心，天津300060；2.湖北省恩施市中心医院妇产科，恩施445000）

Author(s):

YAN Yun-fei¹; LIU Na¹; YE Bei-bei¹; YANG Rong¹; 2; ZHANG Wen-chao¹; WANG Xu-dong¹

（1.Department of Maxillofacial and Otorhinolaryngology Oncology，Cancer Institute and Hospital，Tianjin Medical University，Key Laboratory of Cancer Prevention and Therapy，Tianjin Cancer Institute，National Clinical Research center of Cancer，Tianjin 300060，China；2. Department of Obstetrics and Gynecology，The Central Hospital of Enshi，Enshi 445000，China）

关键词:

喉前淋巴结; 甲状腺乳头状癌; 中央区淋巴结转移; 侧颈淋巴结转移; 手术范围

Keywords:

delphian lymph node;  papillary thyroid carcinoma; central lymph node metastasis; lateral lymph node metastasis; extent of surgeries

分类号:

R736.1

DOI:

-

文献标志码:

A

摘要:

目的：探讨在甲状腺乳头状癌（PTC）中，喉前淋巴结（DLN）转移与颈部其他淋巴结转移的相关性。方法：回顾性分析533例行手术治疗且有DLN检出的PTC患者，分为DLN-阳性组（139例）和DLN-阴性组（394例），比较两组患者临床病理特征及颈部淋巴结转移情况。结果：在533例PTC患者中，DLN的转移率为26.08％（139/533），16例仅发生DLN转移而无其他中央区淋巴结转移。单因素分析显示，肿瘤直径>1 cm（P<0.001），多灶（P=0.002），位于中上1/3（P=0.047），临近被膜（P=0.011），中央区（P<0.001）及侧颈淋巴结转移（P<0.001），淋巴脉管浸润（P=0.014），甲状腺外侵犯（P<0.001），高侵袭性病理亚型（P=0.013）与DLN转移有关。多因素分析显示，肿瘤直径>1 cm（OR=0.466，P=0.001），位于中上1/3（OR=1.748，P=0.024），中央区（OR=0.180，P<0.001）及侧颈淋巴结转移（OR=0.468，P=0.003）和淋巴脉管浸润（OR=0.294，P=0.005）是DLN转移的独立危险因素。DLN阳性患者同侧及对侧中央区淋巴结转移率和侧颈淋巴结转移率更高（P<0.05），且有更多的淋巴结转移数目（P<0.05）。结论：PTC术中应规范清扫喉前及锥状叶周围的淋巴及软组织，对于DLN转移，尤其高侵袭亚型者，建议行全甲状腺切除及双侧中央区淋巴结清扫，必要时选择性侧颈淋巴结清扫。

Abstract:

Objective: To explore the correlation between delphian lymph node（DLN） metastasis and cervical lymph node metastasis in papillary thyroid carcinoma（PTC）. Methods: A total of 533 PTC patients with DLN detection after surgical treatment were retrospectively analyzed，divided into DLN-positive（139 cases） and DLN-negative（394 cases） groups. Clinicopathological factors and cervical lymph nodes metastases were compared between the two groups. Results: Among the 533 PTC patients with DLN detected，139 patients had DLN metastasis，with a DLN metastasis rate of 26.08%（139/533），and 16 patients only had DLN metastasis without other central lymph node metastasis （CLNM）. Univariate analysis showed that the tumor diameter > 1 cm（P<0.001），multifocality（P=0.002），location in the upper 1/3（P=0.047） and close to capsule（P=0.011），CLNM（P<0.001） and lateral lymph node metastasis （LLNM）（P<0.001），lymphovascular invasion（P=0.014），extrathyroidal extension（P<0.001），and aggressive pathological variants（P=0.013） were related to DLN metastasis. Multivariate analysis showed that the tumor diameter > 1 cm（OR=0.466，P=0.001），location in upper 1/3（OR=1.748，P=0.024），CLNM（OR=0.180，P<0.001） and LLNM（OR=0.468，P=0.003） and lymphovascular invasion（OR=0.294，P=0.005） were independent risk factors for DLN metastasis. The incidence of ipsilateral or contralateral CLNM and LLNM was higher in patients with DLN metastasis （P<0.05），with a larger number of lymph nodes metastases（P<0.05）. Conclusion: During PTC operation，lymph and soft tissue in the prelaryngeal region and around the cone lobes should be dissected in a standard manner. For patients with DLN metastasis，especially those with aggressive pathological variants，total thyroidectomy and bilateral central lymph node dissection（CLND） are recommended，and selective lateral lymph node dissection （LLND） should be performed if necessary.

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备注/Memo

备注/Memo:

基金项目： 天津市肿瘤医院临床试验基金(C1710)
作者简介： 闫云飞(1995-)，女，硕士在读，研究方向：头颈部肿瘤；通信作者：张文超，E-mail：zwbeyond_999@sina.com；王旭东，E-mail：wxd.1133@163.com。

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更新日期/Last Update: 2021-07-25