發(fā)布時(shí)間：2018-10-24 13:53

【摘要】：目的研究相關(guān)臨床病例資料,探討成人與兒童及青少年甲狀腺乳頭狀癌在臨床病理特征方面的差異。進(jìn)一步分析兒童及青少年甲狀腺乳頭狀癌轉(zhuǎn)移特點(diǎn)及危險(xiǎn)因素以指導(dǎo)臨床治療。方法回顧性研究2011年2月至2017年2月就診于鄭州大學(xué)第一附屬醫(yī)院甲狀腺外科,首次行手術(shù)治療并經(jīng)術(shù)后常規(guī)病理確診為甲狀腺乳頭狀癌,發(fā)病年齡小于等于18歲的兒童及青少年患者的臨床病例資料135份。同時(shí)收集首診于我院,發(fā)病年齡大于18歲成人經(jīng)手術(shù)治療后常規(guī)病理結(jié)果為甲狀腺乳頭狀癌病例資料120份。統(tǒng)計(jì)分析成人組與兒童及青少年組臨床病理方面的差異。同時(shí)分析兒童及青少年組中患者的頸部淋巴結(jié)轉(zhuǎn)移及肺轉(zhuǎn)移臨床特征及相關(guān)風(fēng)險(xiǎn)因素。結(jié)果135例兒童及青少年患者年齡從3歲至18歲,中位年齡為16歲。男性患者33例,女性患者102例。最大腫瘤直徑7.5cm,最小直徑0.3cm,腫瘤直徑中位數(shù)1.7cm。腫瘤病灶單發(fā)96例,腫瘤病灶多發(fā)39例。腫瘤合并橋本31例,腫瘤未合并橋本104例。腫瘤侵犯被膜31例,腫瘤無被膜侵犯104例。頸部淋巴結(jié)轉(zhuǎn)移97例,轉(zhuǎn)移淋巴結(jié)中位數(shù)4個(gè),無頸部淋巴結(jié)轉(zhuǎn)移38例。肺轉(zhuǎn)移17例,無肺轉(zhuǎn)移118例。治療后復(fù)發(fā)28例,治療后無復(fù)發(fā)107例。120例成人患者年齡從23歲至74歲,中位年齡為45歲。男性患者26例,女性患者94例。最大腫瘤直徑6cm,最小腫瘤直徑0.1cm,腫瘤直徑中位數(shù)0.9cm。腫瘤病灶單發(fā)85例,腫瘤病灶多發(fā)35例。腫瘤合并橋本13例,腫瘤未合并橋本107。腫瘤侵犯被膜16例,腫瘤無被膜侵犯104例。頸部淋巴結(jié)轉(zhuǎn)移42例,轉(zhuǎn)移淋巴結(jié)中位數(shù)0個(gè),無頸部淋巴結(jié)轉(zhuǎn)移78例。肺轉(zhuǎn)移4例,無肺轉(zhuǎn)移116例。治療后復(fù)發(fā)8例,治療后無復(fù)發(fā)112例。統(tǒng)計(jì)分析發(fā)現(xiàn):1.成人甲狀腺乳頭狀癌與兒童及青少年相比,在腫瘤直徑(Z=-5.416)、淋巴結(jié)轉(zhuǎn)移數(shù)(Z=-6.722)、腫瘤合并橋本(χ2=6.547)、被膜侵犯(χ2=3.918)、肺轉(zhuǎn)移(χ2=7.207)、復(fù)發(fā)(χ2=10.379)有明顯差異。2.經(jīng)Spearman秩相關(guān)分析兒童及青少年甲狀腺乳頭狀癌腫瘤直徑大小與頸部淋巴結(jié)轉(zhuǎn)移數(shù)相關(guān),相關(guān)系數(shù)(r=0.221)。3.經(jīng)logistic回歸分析,腫瘤直徑大小是兒童及青少年甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)因素(OR=63.572),被膜侵犯、病灶數(shù)是兒童及青少年甲狀腺乳頭狀癌肺轉(zhuǎn)移的危險(xiǎn)因素(OR值為6.598、10.933)。結(jié)論1.兒童及青少年甲狀腺乳頭狀癌與成人相比,腫瘤直徑較大,頸部淋巴結(jié)轉(zhuǎn)移更嚴(yán)重,腫瘤合并橋本、被膜受侵犯、肺轉(zhuǎn)移、復(fù)發(fā)幾率較高。2.腫瘤直徑大于1cm的兒童及青少年P(guān)TC發(fā)生頸部淋巴結(jié)轉(zhuǎn)移的風(fēng)險(xiǎn)相對較高,且腫瘤直徑越大,頸部淋巴結(jié)轉(zhuǎn)移個(gè)數(shù)越多。3.對于被膜受侵犯、多病灶的兒童甲狀腺乳頭狀癌患者,其發(fā)生肺轉(zhuǎn)移的風(fēng)險(xiǎn)明顯增加。
[Abstract]:Objective to investigate the clinicopathological characteristics of papillary thyroid carcinoma in adults, children and adolescents. To further analyze the characteristics and risk factors of papillary thyroid carcinoma metastasis in children and adolescents to guide the clinical treatment. Methods from February 2011 to February 2017, thyroid carcinoma was diagnosed as papillary thyroid carcinoma in the first affiliated Hospital of Zhengzhou University. 135 clinical data of children and adolescents aged less than 18 years. At the same time, 120 cases of papillary thyroid carcinoma were collected. The differences of clinicopathology between adults and children and adolescents were analyzed statistically. The clinical features and risk factors of cervical lymph node metastasis and lung metastasis in children and adolescents were analyzed. Results the age of 135 children and adolescents ranged from 3 to 18 years old, with a median age of 16 years. There were 33 males and 102 females. The maximum diameter of tumor was 7.5 cm, the minimum diameter was 0.3 cm, and the median diameter of tumor was 1.7 cm. There were 96 cases with single tumor focus and 39 cases with multiple tumor focus. There were 31 cases of tumor with Hashimoto and 104 cases of tumor without Hashimoto. There were 31 cases of tumor invasion of the capsule and 104 cases of tumor without invasion of the capsule. There were 97 cases of cervical lymph node metastasis, 4 cases of metastatic lymph node and 38 cases of no cervical lymph node metastasis. There were 17 cases of lung metastasis and 118 cases of no lung metastasis. The age of 120 adult patients ranged from 23 to 74 years old, with a median age of 45 years. There were 26 males and 94 females. The maximum tumor diameter was 6 cm, the smallest tumor diameter was 0.1 cm, and the median tumor diameter was 0.9 cm. There were 85 cases with single tumor focus and 35 cases with multiple tumor focus. There were 13 cases of tumor with Hashimoto and 107 cases of tumor without Hashimoto. There were 16 cases of tumor invading the capsule and 104 cases of tumor without invasion of the capsule. There were 42 cases of cervical lymph node metastasis, the median of metastatic lymph nodes was 0, and 78 cases without cervical lymph node metastasis. Pulmonary metastasis occurred in 4 cases and no lung metastasis in 116 cases. There were 8 cases of recurrence after treatment and 112 cases of no recurrence after treatment. Statistical analysis found that: 1. Compared with children and adolescents, there were significant differences in diameter of tumor (Z _ (-5.416), number of lymph node metastasis (Z ~ (-6.722), tumor with Hashimoto (蠂 ~ (2) 6.547), invasion of membrane (蠂 ~ (2) = 3.918), pulmonary metastasis (蠂 ~ (22n) 7.207) and recurrence (蠂 ~ (210.379) in adult thyroid papillary carcinoma. The diameter of papillary thyroid carcinoma in children and adolescents was correlated with the number of cervical lymph node metastasis by Spearman rank correlation analysis (r = 0.221). Logistic regression analysis showed that tumor diameter was a risk factor for cervical lymph node metastasis (OR=63.572) in children and adolescents, and the number of lesions was a risk factor for lung metastasis in children and adolescents (OR = 6.59810. 933). Conclusion 1. Compared with adults, papillary thyroid carcinoma in children and adolescents is larger in diameter, more serious in cervical lymph node metastasis, and more likely to recur with Hashimoto, membranous invasion, lung metastasis and recurrence. Children and adolescents with tumor diameter larger than 1cm had a higher risk of cervical lymph node metastasis, and the larger the tumor diameter, the greater the number of cervical lymph node metastasis. In children with papillary thyroid carcinoma with multiple lesions, the risk of lung metastasis was significantly increased.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R736.1
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本文編號：2291595