本文選題：跳躍性轉(zhuǎn)移 + 頸淋巴結(jié)轉(zhuǎn)移規(guī)律��； 參考：《吉林大學(xué)》2016年碩士論文

【摘要】：目的:探討甲狀腺乳頭狀癌側(cè)頸淋巴結(jié)轉(zhuǎn)移的規(guī)律以及影響因素,從而指導(dǎo)臨床行側(cè)頸清掃術(shù)。方法:總結(jié)2013年1月至2015年11月于我科因行全甲加多功能保留頸清掃術(shù)的PTC共計(jì)247例住院病例。患者納入標(biāo)準(zhǔn):病例資料完善,均行多功能保留頸清掃術(shù)且術(shù)后石蠟病理明確診斷為甲狀腺乳頭狀癌。統(tǒng)計(jì)分析側(cè)頸區(qū)的轉(zhuǎn)移規(guī)律及危險(xiǎn)因素和頸部超聲的診斷價(jià)值。結(jié)果:247例患者中,男女比例為81:166(1:2.04),患者年齡9-74歲(42.63±10.59歲)。原發(fā)灶直徑0.4-9.0cm;單葉病變122例,雙葉病變125例。側(cè)頸區(qū)陽(yáng)性205例,頸部各分區(qū)所占比例依次為III區(qū)(73.7%)、IV區(qū)(60.6%)、II區(qū)(53.6%)和V區(qū)(13.7%)。單區(qū)轉(zhuǎn)移71例,多區(qū)轉(zhuǎn)移134例。其中VI區(qū)未轉(zhuǎn)移而側(cè)頸轉(zhuǎn)移,即跳躍性轉(zhuǎn)移為24例,結(jié)果顯示年齡大于45歲及腫瘤位置在上部或中部與跳躍性轉(zhuǎn)移率有關(guān)系。經(jīng)過(guò)單因素和多因素回歸分析顯示,中央?yún)^(qū)淋巴結(jié)陽(yáng)性是側(cè)頸淋巴結(jié)轉(zhuǎn)移的危險(xiǎn)因素。中央?yún)^(qū)陽(yáng)性個(gè)數(shù)與側(cè)頸區(qū)轉(zhuǎn)移率相關(guān)的ROC曲線下面積為0.771,其診斷準(zhǔn)確性為中等。當(dāng)中央?yún)^(qū)陽(yáng)性個(gè)數(shù)大于等于3個(gè),判斷側(cè)頸區(qū)轉(zhuǎn)移的約登指數(shù)最大。當(dāng)中央?yún)^(qū)陽(yáng)性個(gè)數(shù)大于等于5個(gè),多區(qū)轉(zhuǎn)移的比例增加。超聲對(duì)于側(cè)頸區(qū)轉(zhuǎn)移的敏感性較高,特異性不高,各可疑的超聲特點(diǎn)具有良好的預(yù)測(cè)側(cè)頸淋巴結(jié)轉(zhuǎn)移的作用�？梢商卣鲾�(shù)目增多時(shí),側(cè)頸區(qū)發(fā)生轉(zhuǎn)移例數(shù)也在增多。結(jié)論:1.側(cè)頸區(qū)轉(zhuǎn)移以Ⅲ區(qū)最多,然后為Ⅳ區(qū)和Ⅱ區(qū),V區(qū)相對(duì)較少。所受累的區(qū)域來(lái)看,以多區(qū)受累比例大。2.跳躍性轉(zhuǎn)移的發(fā)生率較低,但年齡大于45歲和腫瘤位于上極或中極要結(jié)合術(shù)前或術(shù)中彩超,警惕跳躍性轉(zhuǎn)移出現(xiàn)。3.側(cè)頸區(qū)出現(xiàn)轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素為中央?yún)^(qū)陽(yáng)性,并且陽(yáng)性個(gè)數(shù)越多,側(cè)頸轉(zhuǎn)移率越高。4.超聲對(duì)于側(cè)頸淋巴結(jié)轉(zhuǎn)移的診斷具有重要作用,隨著可疑特征數(shù)目增多,其診斷率也相應(yīng)增加。
[Abstract]:Objective: to investigate the regularity and influencing factors of cervical lymph node metastasis in papillary thyroid carcinoma. Methods: from January 2013 to November 2015, a total of 247 cases of PTC underwent total thyroidism plus multifunctional neck preserving dissection in our department. Patient inclusion criteria: the case data were perfect, all patients underwent multifunctional neck preserving dissection and paraffin wax pathology after operation was clearly diagnosed as papillary thyroid carcinoma. Statistical analysis of the lateral cervical region metastasis and risk factors and the diagnostic value of cervical ultrasound. Results among 247 patients, the ratio of male to female was 81: 166: 2.04, and the age of the patient was 42.63 鹵10.59 years old. The diameter of the primary lesion was 0.4-9.0 cm, the single lobe lesion was 122 cases, the double lobe lesion was 125 cases. 205 cases were positive in the lateral cervical area, and the proportion of the cervical regions was 73.73.7in the third region, and 60.6% in the IV area and 53.6% in the second part) and 13.7% in the V area. There were 71 cases of single area metastasis and 134 cases of multi-region metastasis. There were 24 cases of leaping metastasis of lateral neck without metastasis in VI region. The results showed that the age over 45 years old and the location of tumor in the upper or middle part were related to the rate of skip metastasis. Univariate and multivariate regression analysis showed that central lymph node positive was the risk factor of lateral cervical lymph node metastasis. The area under the ROC curve was 0.771and the diagnostic accuracy was moderate. When the number of positive areas in the central region was greater than or equal to 3, the Yorden index of lateral cervical metastasis was the largest. When the positive number of the central region was greater than or equal to 5, the proportion of multi-region metastasis increased. The sensitivity and specificity of ultrasound for lateral cervical lymph node metastasis were high, and the suspicious features of ultrasound had a good predictive effect on lateral cervical lymph node metastasis. When the number of suspicious features increased, the number of metastatic cases in the lateral cervical region was also increasing. Conclusion 1. The metastases of the lateral cervical region were mostly in region 鈪，

本文編號(hào)：2021017