本文選題：甲狀腺乳頭狀癌 + 甲狀腺微小乳頭狀癌��； 參考：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討甲狀腺乳頭狀癌淋巴結(jié)轉(zhuǎn)移相關(guān)危險(xiǎn)因素。方法:收集于2002年07月至2016年06月在我科診治的甲狀腺乳頭狀癌患者202例,所有患者均行頸部淋巴結(jié)清掃術(shù),其中行中央+側(cè)頸區(qū)淋巴結(jié)清掃術(shù)93例,單純行中央?yún)^(qū)淋巴結(jié)清掃術(shù)109例。納入患者的性別、年齡、病灶單雙側(cè)、腫瘤直徑、是否多發(fā)病灶、是否微小癌及術(shù)前血小板計(jì)數(shù)、合并慢性全身性疾病、吸煙史、飲酒史等因素,與頸部淋巴結(jié)轉(zhuǎn)移情況。計(jì)數(shù)資料用頻數(shù)表示,兩組率的比較即單因素分析采用卡方檢驗(yàn),相應(yīng)P值0.1的因素進(jìn)行后續(xù)的多因素分析。多因素分析采用二分類Logistic回歸分析。以P0.05(雙側(cè))為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:202例患者中,共有頸部淋巴結(jié)轉(zhuǎn)移96例。單因素分析顯示:性別(X~2=4.589,P=0.032)、年齡(X~2=11.384,P=0.001)、單雙側(cè)病灶(X~2=9.700,P=0.002)、微小癌(X~2=8.020,P=0.005)、血小板計(jì)數(shù)(X~2=7.980,P=0.005)與甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移有關(guān)。多因素二分類Logistic回歸分析顯示:性別(P=0.045,OR=0.461,95%CI=0.216-0.984)、年齡(P=0.004,OR=0.357,95%CI=0.176-0.726)、單雙側(cè)病灶(P=0.001,OR=6.610,95%CI=2.280-19.169)、血小板計(jì)數(shù)(P=0.005,OR=3.282,95%CI=1.438-7.491)、微小癌(P=0.001,OR=0.215,95%CI=0.083-0.555)為甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移的獨(dú)立影響因素。在研究中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移的患者出現(xiàn)側(cè)頸部淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)分析中,單因素分析顯示:性別(X~2=5.800,P=0.016)、年齡(X~2=9.896,P=0.002)與甲狀腺乳頭狀癌側(cè)頸部淋巴結(jié)轉(zhuǎn)移相關(guān),多因素分析發(fā)現(xiàn):性別(P=0.026,OR=0.199,95%CI=0.048-0.827)、年齡(P=0.002,OR=0.153,95%CI=0.046-0.516)為甲狀腺乳頭狀癌側(cè)頸部淋巴結(jié)轉(zhuǎn)移的獨(dú)立影響因素。40例微小乳頭狀癌患者分析中,我們發(fā)現(xiàn)單雙側(cè)病灶與其頸部淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)相關(guān)(X~2=7.343,P=0.007)。經(jīng)對(duì)84例甲狀腺癌cN0患者分析后發(fā)現(xiàn)術(shù)前血小板計(jì)數(shù)與其頸部淋巴結(jié)轉(zhuǎn)移相關(guān)(X~2=5.411,P=0.020)。結(jié)論:男性、年齡≤45歲、雙側(cè)病灶、血小板計(jì)數(shù)300×109/L、腫瘤直徑1cm是甲狀腺乳頭狀癌頸部淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)因素。對(duì)于中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移的患者,男性、年齡≤45歲是其出現(xiàn)側(cè)頸部淋巴結(jié)轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素。雙側(cè)病灶與甲狀腺乳頭狀微小癌患者頸部淋巴結(jié)轉(zhuǎn)移有關(guān)。術(shù)前血小板計(jì)數(shù)與cN0甲狀腺乳頭狀癌患者頸部淋巴結(jié)轉(zhuǎn)移有關(guān)。
[Abstract]:Objective: to investigate the risk factors associated with lymph node metastasis in papillary thyroid carcinoma.Methods: 202 patients with papillary thyroid carcinoma were collected from July 2002 to June 2016. All the patients underwent neck lymph node dissection, 93 of them underwent central neck dissection.109 cases underwent central lymph node dissection.Gender, age, unilateral and bilateral lesions, tumor diameter, multiple lesions, microcarcinoma and preoperative platelet count, chronic systemic disease, smoking history, drinking history, and cervical lymph node metastasis were taken into account.The counting data are expressed by frequency. The comparison between the two groups is that the single factor analysis is chi-square test, and the corresponding P value 0.1 is used to carry on the subsequent multivariate analysis.Two-classification Logistic regression analysis was used for multivariate analysis.There was significant difference in P 0.05 (bilateral).Results among 202 cases, 96 cases had cervical lymph node metastasis.In the analysis of the risk of lateral cervical lymph node metastasis in patients with lymph node metastasis in central region, univariate analysis showed that the sex of the patients with papillary thyroid carcinoma was 5.800%, the age was 9.896%, and the age was 9.896% (P 0.002), which was associated with the cervical lymph node metastasis of papillary thyroid carcinoma.The multivariate analysis showed that the sex of the papillary thyroid carcinoma was 0.048-0.827 and 0.15395CIQ 0.046-0.516). In the analysis of 40 patients with papillary thyroid carcinoma, we found that the single and bilateral lesions were associated with the risk of cervical lymph node metastasis. We found that the single and bilateral lesions were associated with the risk of cervical lymph node metastasis in patients with papillary thyroid carcinoma.After analysis of 84 cases of thyroid carcinoma with cN0, it was found that preoperative platelet count was associated with cervical lymph node metastasis.Conclusion: male, age 鈮，

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