多灶性甲狀腺乳頭狀癌的臨床分析
發(fā)布時間：2018-10-11 14:44
【摘要】：目的：多中心性是內(nèi)分泌腫瘤的共有特點(diǎn),多灶性甲狀腺乳頭狀癌(multifocal papillary thyroid carcinoma, MPTC)同樣較為常見。多發(fā)病灶與甲狀腺癌的轉(zhuǎn)移情況及預(yù)后相關(guān),本課題旨在分析探討MPTC患者的構(gòu)成結(jié)構(gòu)及臨床特點(diǎn),為MPTC的診療提供一定的理論依據(jù)。方法：回顧性分析山東省立醫(yī)院2012年01月至2013年12月首次接受甲狀腺手術(shù)且術(shù)后石蠟病理確診為甲狀腺乳頭狀癌的病例404例,按石蠟病理癌灶個數(shù)分組,癌灶數(shù)=1者為單灶組；癌灶數(shù)12者為多灶組。所有數(shù)據(jù)采用SPSS 19.0統(tǒng)計軟件進(jìn)行分析。結(jié)果：在搜集的404例甲狀腺乳頭狀癌患者中,多灶組病例145例,占搜集總PTC病例的35.9%,平均年齡多灶組41.72歲,單灶組44.56歲(T檢驗(yàn)P=0.23)。術(shù)前甲狀腺彩超提示鈣化者多灶組85.5%(124例)較單灶組59.5%(154例)高(x2=29.411,P=0.000)；多灶組男性患者所占比例22.1%(32例)較單灶組男性患者所占比例8.9%(23例)高(x2=13.749,P=0.000)；術(shù)后病理有淋巴結(jié)轉(zhuǎn)移者多灶組50.3%(73例)較單灶組31.7%(82例)高(x2=13.724,P=0.000)；病灶有周圍組織侵犯者多灶組29.7%(43例)高于單灶組12.4%(32例)(x2=18.403,P=0.000)；合并結(jié)節(jié)性甲狀腺腫者比例多灶組38.6%(56例)較單灶組43.6%(113例)低(x2=0.958,P=0.328)；合并橋本氏甲狀腺炎者比例多灶組29.7%(43例)較單灶組30.9%(80例)低(x2=0.067,P=0.796)；微小乳頭狀癌比例多灶組46.9%(68例)較單灶組55.2%(143例)低(x2=2.576,P=0.108)；所有404例PTC患者中,是否合并結(jié)節(jié)性甲狀腺腫與是否合并橋本氏甲狀腺炎對淋巴結(jié)轉(zhuǎn)移率并無顯著影響。在145例MPTC患者中,病灶數(shù)=2者93例(43.1%),病灶數(shù)2者52例(56.9%)；病灶位于單側(cè)者47例(32.4%),位于雙側(cè)者98例(67.6%)；微小乳頭狀癌68例(46.9%),非微小乳頭狀癌77例(53.1%)。多灶組中病理類型為微小乳頭狀癌者淋巴結(jié)轉(zhuǎn)移率(38.2%)明顯低于非微小乳頭狀癌者(61.0%)(x2=7.556,P=0.006)；病灶位于單側(cè)還是雙側(cè)以及病灶個數(shù)是否大于2個對淋巴結(jié)轉(zhuǎn)移率的影響無統(tǒng)計學(xué)意義。結(jié)論：甲狀腺乳頭狀癌患者中,多灶組病灶鈣化出現(xiàn)率明顯高于單灶組；多灶組男性患者比例高于單灶組,因此,在男性PTC患者的診療中,更應(yīng)注意病變的多灶性,以免漏診；多灶組周圍組織侵犯率及淋巴結(jié)轉(zhuǎn)移率明顯高于單灶組,因此在行MPTC患者手術(shù)時,即使術(shù)前頸部淋巴結(jié)超聲未提示有淋巴結(jié)轉(zhuǎn)移時,依舊建議同時行中央組淋巴結(jié)清掃術(shù)；此外,在甲狀腺乳頭狀癌患者中,多灶組和單灶組在發(fā)病年齡、腫瘤大小、是否合并結(jié)節(jié)性甲狀腺腫及是否合并橋本氏甲狀腺炎上無統(tǒng)計學(xué)差異,說明其可能不是影響MPTC發(fā)病的因素。在MPTC患者中2個以上病灶者占大多數(shù),病灶位于雙側(cè)者多于單側(cè)發(fā)病者；但二者對淋巴結(jié)轉(zhuǎn)移率的影響無統(tǒng)計學(xué)意義。病灶直徑大于1cm者比病灶直徑小于1cm者淋巴結(jié)轉(zhuǎn)移率明顯增高。因此,對腫瘤直徑較大者而超聲未提示有淋巴結(jié)轉(zhuǎn)移者,同樣建議行甲狀腺全切+中央組淋巴結(jié)清掃術(shù),并根據(jù)病理酌情擴(kuò)大清掃范圍。
[Abstract]:Objective: Multicenter is a common characteristic of endocrine tumor, and multi-focal thyroid papillary carcinoma (MPTC) is also common. The aim of this study is to analyze the structure and clinical characteristics of MPTC, and provide some theoretical basis for diagnosis and treatment of MPTC. Methods: A retrospective analysis of 404 cases of thyroid papillary carcinoma was performed from January 2012 to December 2013 in Shandong province from January 2012 to December 2013. All data were analyzed using SPSS 19. 0 statistical software. Results: Among 404 cases of thyroid papillary carcinoma, 145 cases were selected, accounting for 35. 9% of total PTC cases, 41. 72 years old and 44. 56 years old (T test P = 0. 23). The preoperative thyroid color Doppler ultrasound indicated that there were 85.5% (124 cases) of patients with calcification and 59.5% (154 cases) higher (x2 = 29. 411, P = 0. 000). The proportion of male patients in multi-range group was 22. 1% (32 cases), which was 80.9% (23 cases) higher than that in single-range group (x2 = 13.749, P = 0.000). There were 50.3% (73 cases) of patients with lymph node metastasis after operation, and 31.7% (82 cases) were higher (x2 = 13.724, P = 0. 000). There were 29. 7% (43 cases) of the lesions around the lesion were higher than that in the single range group (12.4% (32 cases) (x2 = 18. 403, P = 0. 000); 32.6% (56 cases) of the group with nodular goiter were lower (x2 = 0.9958) than that in the single range group (40.6%) (113 cases). P = 0. 328); 29. 7% (43 cases) of the proportion of multi-focus group in the patients with thyroiditis were lower (x2 = 0.067, P = 0.796). The proportion of micropapillary carcinoma was 46. 9% (68 cases) than that in the single range group (55.2% (143 cases) (x2 = 2.576, P = 0. 108); all 404 PTC patients, Whether it was combined with nodular goiter had no significant effect on the rate of lymph node metastasis. Among 145 patients with MPTC, the number of lesions = 2, 93 (43. 1%), 52 cases (56. 9%), and 47 cases (36.4%) in one side, 98 cases (66.7%) in double side, 68 cases (46. 9%) of micropapillary carcinoma, 77 cases of non-small papillary carcinoma (53. 1%). The lymph node metastasis rate (38. 2%) in the multi-focal group was significantly lower than that of non-small papillary carcinoma (61.0%) (x2 = 7. 556, P = 0. 006), and whether the lesion was located on one side or the double side and whether the number of lesions was greater than 2 had no statistical significance on the lymph node metastasis rate. Conclusion: In patients with thyroid papillary carcinoma, the occurrence rate of calcification of focal lesion in multi-range group is significantly higher than that of single-range group, and the proportion of male patients in multi-range group is higher than that of single-range group. Therefore, in diagnosis and treatment of male PTC patients, more attention should be paid to the multi-range of lesions, so as to avoid missed diagnosis. The incidence of tissue invasion and lymph node metastasis in multi-range group were significantly higher than that in single range group. Therefore, in patients undergoing MPTC, even before operation, lymph node dissection in central group was still suggested, and in patients with papillary thyroid carcinoma, There was no statistical difference in the age of onset, size of tumor, whether it was combined with nodular goiter and whether it was combined with the thyroiditis of patients with multiple foci and single foci, suggesting that it may not affect the pathogenesis of MPTC. In MPTC patients, 2 or more lesions accounted for most of the lesions, and the lesions were located on more than one side of the two sides; however, the effect of the two lesions on lymph node metastasis was not statistically significant. The diameter of lesion was larger than that of 1cm, and the rate of lymph node metastasis was significantly higher than that of 1cm. Therefore, no lymph node metastasis was suggested to the larger diameter of the tumor, and it was suggested that the lymph node dissection in the central group should be performed in the whole thyroidectomy + central group, and the scope of the dissection should be expanded as appropriate.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R736.1
本文編號：2264453
[Abstract]:Objective: Multicenter is a common characteristic of endocrine tumor, and multi-focal thyroid papillary carcinoma (MPTC) is also common. The aim of this study is to analyze the structure and clinical characteristics of MPTC, and provide some theoretical basis for diagnosis and treatment of MPTC. Methods: A retrospective analysis of 404 cases of thyroid papillary carcinoma was performed from January 2012 to December 2013 in Shandong province from January 2012 to December 2013. All data were analyzed using SPSS 19. 0 statistical software. Results: Among 404 cases of thyroid papillary carcinoma, 145 cases were selected, accounting for 35. 9% of total PTC cases, 41. 72 years old and 44. 56 years old (T test P = 0. 23). The preoperative thyroid color Doppler ultrasound indicated that there were 85.5% (124 cases) of patients with calcification and 59.5% (154 cases) higher (x2 = 29. 411, P = 0. 000). The proportion of male patients in multi-range group was 22. 1% (32 cases), which was 80.9% (23 cases) higher than that in single-range group (x2 = 13.749, P = 0.000). There were 50.3% (73 cases) of patients with lymph node metastasis after operation, and 31.7% (82 cases) were higher (x2 = 13.724, P = 0. 000). There were 29. 7% (43 cases) of the lesions around the lesion were higher than that in the single range group (12.4% (32 cases) (x2 = 18. 403, P = 0. 000); 32.6% (56 cases) of the group with nodular goiter were lower (x2 = 0.9958) than that in the single range group (40.6%) (113 cases). P = 0. 328); 29. 7% (43 cases) of the proportion of multi-focus group in the patients with thyroiditis were lower (x2 = 0.067, P = 0.796). The proportion of micropapillary carcinoma was 46. 9% (68 cases) than that in the single range group (55.2% (143 cases) (x2 = 2.576, P = 0. 108); all 404 PTC patients, Whether it was combined with nodular goiter had no significant effect on the rate of lymph node metastasis. Among 145 patients with MPTC, the number of lesions = 2, 93 (43. 1%), 52 cases (56. 9%), and 47 cases (36.4%) in one side, 98 cases (66.7%) in double side, 68 cases (46. 9%) of micropapillary carcinoma, 77 cases of non-small papillary carcinoma (53. 1%). The lymph node metastasis rate (38. 2%) in the multi-focal group was significantly lower than that of non-small papillary carcinoma (61.0%) (x2 = 7. 556, P = 0. 006), and whether the lesion was located on one side or the double side and whether the number of lesions was greater than 2 had no statistical significance on the lymph node metastasis rate. Conclusion: In patients with thyroid papillary carcinoma, the occurrence rate of calcification of focal lesion in multi-range group is significantly higher than that of single-range group, and the proportion of male patients in multi-range group is higher than that of single-range group. Therefore, in diagnosis and treatment of male PTC patients, more attention should be paid to the multi-range of lesions, so as to avoid missed diagnosis. The incidence of tissue invasion and lymph node metastasis in multi-range group were significantly higher than that in single range group. Therefore, in patients undergoing MPTC, even before operation, lymph node dissection in central group was still suggested, and in patients with papillary thyroid carcinoma, There was no statistical difference in the age of onset, size of tumor, whether it was combined with nodular goiter and whether it was combined with the thyroiditis of patients with multiple foci and single foci, suggesting that it may not affect the pathogenesis of MPTC. In MPTC patients, 2 or more lesions accounted for most of the lesions, and the lesions were located on more than one side of the two sides; however, the effect of the two lesions on lymph node metastasis was not statistically significant. The diameter of lesion was larger than that of 1cm, and the rate of lymph node metastasis was significantly higher than that of 1cm. Therefore, no lymph node metastasis was suggested to the larger diameter of the tumor, and it was suggested that the lymph node dissection in the central group should be performed in the whole thyroidectomy + central group, and the scope of the dissection should be expanded as appropriate.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R736.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 林僖;李安華;賴非云;韓峰;陳芳;;甲狀腺超聲造影及定量分析的優(yōu)化方法學(xué)研究[J];中國超聲醫(yī)學(xué)雜志;2007年07期
2 周萍;詹維偉;任新平;周建橋;陳曼;;超聲彈性成像診斷甲狀腺結(jié)節(jié)的價值[J];中國醫(yī)學(xué)影像學(xué)雜志;2009年04期
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