【摘要】：目的:分析甲狀腺微小結(jié)節(jié)患者的臨床病理特征和甲狀腺乳頭狀癌患者側(cè)頸區(qū)淋巴結(jié)轉(zhuǎn)移的相關(guān)指標(biāo),提高對(duì)甲狀腺微小結(jié)節(jié)和側(cè)頸部淋巴結(jié)轉(zhuǎn)移的早期診治水平。避免過(guò)度和延誤治療的發(fā)生。方法:選擇就診于新疆醫(yī)科大學(xué)附屬醫(yī)院2011年1月至2015年12月間,經(jīng)超聲TI-RADS分級(jí)標(biāo)準(zhǔn)診斷為3級(jí)或4a級(jí)的108例甲狀腺微小結(jié)節(jié)患者和進(jìn)行側(cè)頸部淋巴結(jié)清掃術(shù)的96例患者,分別進(jìn)行隨訪觀察和病例資料的回顧性分析。其中門(mén)診和電話隨訪截止至2015年9月,以隨訪結(jié)束時(shí)患者甲狀腺結(jié)節(jié)是否為惡性作為統(tǒng)計(jì)分析的終點(diǎn)事件;回顧分析病例資料中Ki-67、CD56、糖鏈抗原19-9的表達(dá)情況、Ⅵ區(qū)淋巴結(jié)個(gè)數(shù)與側(cè)方淋巴結(jié)轉(zhuǎn)移之間的關(guān)系。結(jié)果:隨訪研究中有23例患者出現(xiàn)疾病進(jìn)展,經(jīng)術(shù)后病理診斷為甲狀腺微小癌。甲狀腺微小良性結(jié)節(jié)和甲狀腺微小癌患者性別、年齡、結(jié)節(jié)數(shù)目、是否為多中心腫瘤、TI-RADS分級(jí)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);兩者是否合并其他甲狀腺疾病、是否規(guī)律服用抑制TSH藥物比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。多因素Logistic回歸分析結(jié)果顯示,男性、多發(fā)結(jié)節(jié)、多中心腫瘤、TI-RADS分級(jí)為4a級(jí)是甲狀腺微小癌的影響因素(P0.05)。關(guān)于側(cè)方淋巴結(jié)轉(zhuǎn)移的四項(xiàng)研究指標(biāo)中,Ⅵ區(qū)淋巴結(jié)轉(zhuǎn)移個(gè)數(shù)≥5個(gè)對(duì)提示側(cè)方淋巴結(jié)轉(zhuǎn)移有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:存在男性、多發(fā)結(jié)節(jié)、多中心腫瘤、TI-RADS分級(jí)為4a級(jí)這些高危因素的甲狀腺微小結(jié)節(jié)患者應(yīng)考慮積極手術(shù)治療,不適宜作為長(zhǎng)期隨訪對(duì)象。Ⅵ區(qū)淋巴結(jié)轉(zhuǎn)移個(gè)數(shù)≥5個(gè)的患者宜考慮早期行側(cè)頸部淋巴結(jié)清掃術(shù)。
[Abstract]:Objective: to analyze the clinicopathological features of thyroid micronodule and the related indexes of lymph node metastasis in the lateral cervical region of patients with papillary thyroid carcinoma, so as to improve the early diagnosis and treatment of thyroid micronodule and lateral cervical lymph node metastasis. Avoid excessive and delayed treatment. Methods: from January 2011 to December 2015, 108 patients with grade 3 or grade 4a thyroid micronodules and 96 patients undergoing lateral neck lymph node dissection were selected according to the TI-RADS classification criteria. Follow-up observation and retrospective analysis of case data were carried out. The end point of statistical analysis was whether thyroid nodules were malignant or not at the end of follow-up. The expression of Ki-67,CD56, carbohydrate antigen 19-9 and the relationship between the number of lymph nodes in region 鈪，

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