本文選題：甲狀腺微小癌　切入點：淋巴結(jié)轉(zhuǎn)移　出處：《山西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:1.甲狀腺微小癌頸部中央?yún)^(qū)腫大淋巴結(jié)超聲聲像圖特征。2.超聲對頸中央?yún)^(qū)各亞區(qū)(氣管旁、氣管前、喉前)淋巴結(jié)的檢出率。3.甲狀腺微小癌頸部中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移相關(guān)影響因素分析。方法:選取2013年1至2015年12月于我院體檢或住院超聲檢查發(fā)現(xiàn)甲狀腺可疑腫物并行手術(shù)治療,術(shù)后經(jīng)病理證實為甲狀腺微小癌患者422例,對頸部中央?yún)^(qū)淋巴結(jié)的超聲、術(shù)中及病理診斷結(jié)果進行對照,總結(jié)頸部中央?yún)^(qū)淋巴結(jié)的超聲表現(xiàn),采取單因素和多因素方法分析甲狀腺微小癌頸部中央?yún)^(qū)淋巴轉(zhuǎn)移的相關(guān)影響因素。結(jié)果:422例甲狀腺微小癌患者超聲檢出頸部中央?yún)^(qū)氣管旁128例(30.3%,128/422)276個腫大淋巴結(jié),其中多數(shù)淋巴結(jié)(98.6%,272/276)超聲表現(xiàn)為低回聲、長短徑比≥2(63.8%,176/276)、部分淋巴門結(jié)構(gòu)不清(72.1%,199/276)、血流稀少或無血流顯示(91.7%,253/276)。術(shù)中清掃檢出氣管旁淋巴結(jié)978個,其中522個(53.4%,522/978)淋巴結(jié)長徑≤5.0 mm;術(shù)后經(jīng)病理檢查氣管旁淋巴結(jié)100例(23.7%,100/422)203個發(fā)生轉(zhuǎn)移。頸中央?yún)^(qū)氣管前及喉前淋巴結(jié)超聲未檢出,術(shù)中清掃發(fā)現(xiàn)氣管前和喉前51個腫大淋巴結(jié)(氣管前22例48個腫大淋巴結(jié),喉前3例3個腫大淋巴結(jié));其中30個淋巴結(jié)(58.8%,30/51)長徑≤5.0 mm,5個(9.8%,5/51)淋巴結(jié)長徑10.0 mm;病理檢查顯示氣管前7例13個發(fā)生淋巴轉(zhuǎn)移(氣管旁及氣管前4例同時發(fā)生轉(zhuǎn)移),喉前1例1個淋巴轉(zhuǎn)移(與氣管旁同時發(fā)生轉(zhuǎn)移)。即病理診斷頸中央?yún)^(qū)淋巴結(jié)103例發(fā)生轉(zhuǎn)移(24.4%,103/422)。單因素分析表示年齡45歲(P=0.000)、腫瘤直徑(5mm)(P=0.001)、頸側(cè)區(qū)淋巴結(jié)轉(zhuǎn)移(P=0.000)、多灶(P=0.001)、結(jié)節(jié)內(nèi)微鈣化(P=0.024)的差異有統(tǒng)計學意義(P均0.05)。而性別(P=0.723)、腫瘤部位(P=0.083)、橋本甲狀腺炎(P=0.839)、侵犯被膜(P=0.144)、結(jié)節(jié)內(nèi)回聲(P=0.443)、結(jié)節(jié)邊界(P=0.586)、結(jié)節(jié)縱橫比1(P=0.345)、血流(P=0.999)與CLN轉(zhuǎn)移差異無統(tǒng)計學意義(P均0.05)。多因素分析表示頸側(cè)區(qū)淋巴轉(zhuǎn)移(P=0.000)、多灶(P=0.001)、結(jié)節(jié)內(nèi)微鈣化(P=0.000)為CLN轉(zhuǎn)移危險因素(P均0.05)。結(jié)論:1.甲狀腺微小癌頸部中央?yún)^(qū)腫大淋巴結(jié)術(shù)前超聲具有低回聲、長短徑比≥2、淋巴門結(jié)構(gòu)不清、血供稀少或無血流等特征。2.甲狀腺微小癌患者頸部中央?yún)^(qū)解剖結(jié)構(gòu)復雜,且頸部中央?yún)^(qū)各亞區(qū)淋巴結(jié)所在位置較深,長徑較小,超聲掃查不仔細易漏診;術(shù)前超聲未檢出頸部腫大異常的淋巴結(jié)不能排除微小淋巴結(jié)持續(xù)存在或復發(fā)的危險。3.側(cè)頸區(qū)淋巴轉(zhuǎn)移、多灶、結(jié)節(jié)內(nèi)微鈣化為頸中央?yún)^(qū)淋巴轉(zhuǎn)移的危險因素,術(shù)前超聲掃查甲狀腺可疑惡性病灶,并伴有上述超聲可疑征象時,應對頸中央?yún)^(qū)區(qū)域仔細掃查(尤其氣管前及喉前區(qū)域)。
[Abstract]:Objective 1. Ultrasonographic features of enlarged lymph nodes in the central cervical region of thyroid microcarcinoma. 2. Sonographic analysis of subregions of the central cervical region (paratracheal, pretracheal). Analysis of the related factors of lymph node metastasis in the central cervical region of thyroid microcarcinoma methods: from 2013 to December 2015, suspected thyroid neoplasms were detected by ultrasonography in our hospital from 2013 to December 2015. 422 cases of thyroid microcarcinoma were proved by pathology after operation. The results of ultrasonography, intraoperative and pathological diagnosis of the lymph nodes in the central region of the neck were compared, and the ultrasonographic findings of the lymph nodes in the central region of the neck were summarized. Univariate and multivariate methods were used to analyze the related factors of lymphatic metastasis in the central cervical region of thyroid microcarcinoma. Results 128 cases of paratracheal lymph nodes in the central region of thyroid were detected by ultrasound in 422 cases of thyroid microcarcinoma. Most of the lymph nodes showed hypoechoic echo, the ratio of length to diameter 鈮，

本文編號：1602358