【摘要】：目的:分析甲狀腺微小結節(jié)患者的臨床病理特征和甲狀腺乳頭狀癌患者側頸區(qū)淋巴結轉移的相關指標,提高對甲狀腺微小結節(jié)和側頸部淋巴結轉移的早期診治水平。避免過度和延誤治療的發(fā)生。方法:選擇就診于新疆醫(yī)科大學附屬醫(yī)院2011年1月至2015年12月間,經(jīng)超聲TI-RADS分級標準診斷為3級或4a級的108例甲狀腺微小結節(jié)患者和進行側頸部淋巴結清掃術的96例患者,分別進行隨訪觀察和病例資料的回顧性分析。其中門診和電話隨訪截止至2015年9月,以隨訪結束時患者甲狀腺結節(jié)是否為惡性作為統(tǒng)計分析的終點事件;回顧分析病例資料中Ki-67、CD56、糖鏈抗原19-9的表達情況、Ⅵ區(qū)淋巴結個數(shù)與側方淋巴結轉移之間的關系。結果:隨訪研究中有23例患者出現(xiàn)疾病進展,經(jīng)術后病理診斷為甲狀腺微小癌。甲狀腺微小良性結節(jié)和甲狀腺微小癌患者性別、年齡、結節(jié)數(shù)目、是否為多中心腫瘤、TI-RADS分級比較,差異均有統(tǒng)計學意義(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,差異均無統(tǒng)計學意義(P0.05)。多因素Logistic回歸分析結果顯示,男性、多發(fā)結節(jié)、多中心腫瘤、TI-RADS分級為4a級是甲狀腺微小癌的影響因素(P0.05)。關于側方淋巴結轉移的四項研究指標中,Ⅵ區(qū)淋巴結轉移個數(shù)≥5個對提示側方淋巴結轉移有統(tǒng)計學意義(P0.05)。結論:存在男性、多發(fā)結節(jié)、多中心腫瘤、TI-RADS分級為4a級這些高危因素的甲狀腺微小結節(jié)患者應考慮積極手術治療,不適宜作為長期隨訪對象。Ⅵ區(qū)淋巴結轉移個數(shù)≥5個的患者宜考慮早期行側頸部淋巴結清掃術。
[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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