【摘要】：目的：本文目的是探究影響Delphian淋巴結的轉移情況的臨床因素以及其預測意義，并且探究Delphian淋巴結轉移規(guī)律對甲狀腺乳頭狀癌臨床診療的指導作用。 方法：回顧性分析2013年9月到2015年1月就診于吉林大學第一醫(yī)院行手術治療的探查到Delphian淋巴結并送檢的182例術后石蠟病理確診為甲狀腺乳頭狀癌的病例，單因素分析研究相關臨床因素（包括性別、年齡、腫瘤最大徑，是否多灶，腫瘤是否侵犯甲狀腺被膜、是否合并橋本甲狀腺炎或結節(jié)性甲狀腺腫或甲狀腺腺瘤以及中央?yún)^(qū)氣管旁淋巴結和側頸淋巴結是否陽性）與Delphian淋巴結轉移情況的相關關系，并對有統(tǒng)計學意義（P＜0.05）的臨床因素進行l(wèi)ogistic回歸分析，進一步驗證各臨床因素的影響。對Delphian淋巴結的陽性個數(shù)與中央?yún)^(qū)氣管旁淋巴結及側頸淋巴結轉移率做相關性分析，并研究Delphian淋巴結轉移與腫瘤同側及對側Ⅵ區(qū)淋巴結轉移情況的相關性。 結果：本研究中Delphian淋巴結轉移與年齡（P=0.005）、腫瘤最大直徑（P＜0.001）、是否侵及被膜（P=0.003）以及是否合并橋本甲狀腺炎（P=0.015）的差異有統(tǒng)計學意義（P＜0.05）；與其他臨床特征差異沒有統(tǒng)計學意義；多因素logistic回歸分析示腫瘤最大直徑大于1cm，侵及甲狀腺被膜的P值分別為＜0.001、0.038，OR值分別為4.895、2.563，95%的可信區(qū)間分別為2.401~9.981、1.055~6.226；中央?yún)^(qū)氣管旁淋巴結轉移率與Delphian淋巴結轉移的個數(shù)的Kendall相關系數(shù)與Spearman相關系數(shù)均為1.000，P＜0.01，，側頸淋巴結轉移率與Delphian淋巴結轉移個數(shù)Kendall相關系數(shù)為0.714，Spearman相關系數(shù)為0.739，P＜0.01；Delphian淋巴結陽性時患側與對側Ⅵ區(qū)的淋巴結轉移率均較高（P＜0.05）。 結論：Delphian淋巴結的轉移與患者年齡、腫瘤直徑、是否侵犯被膜及被膜外組織以及是否合并橋本甲狀腺炎等因素有關，腫瘤直徑大于1cm、侵犯甲狀腺被膜是Delphian淋巴結轉移的危險因素；Delphian淋巴結陽性時中央?yún)^(qū)氣管旁淋巴結和側頸淋巴結轉移率分別是Delphian陰性的3倍和1.5倍，并且轉移率均與Delphian淋巴結的陽性個數(shù)呈正相關；Delphian淋巴結陽性癌灶同側及對側Ⅵ區(qū)的轉移率均較高。
[Abstract]:Aim: the purpose of this study is to explore the clinical factors affecting the metastasis of Delphian lymph nodes and its predictive significance, and to explore the role of Delphian lymph node metastasis in the clinical diagnosis and treatment of papillary thyroid carcinoma. Methods: from September 2013 to January 2015, a total of 182 cases of thyroid papillary carcinoma diagnosed as thyroid papillary carcinoma by paraffin-embedded pathology were analyzed retrospectively. The Delphian lymph nodes were detected and examined in the first Hospital of Jilin University from September 2013 to January 2015. Univariate analysis was used to investigate related clinical factors (including sex, age, maximum diameter of tumor, multiple foci, and invasion of thyroid capsule). Whether Hashimoto's thyroiditis or nodular goiter or thyroid adenoma and paratracheal and lateral cervical lymph nodes in the central region were positive) were associated with Delphian lymph node metastasis. The clinical factors with statistical significance were analyzed by logistic regression analysis, and the influence of each clinical factor was further verified. The correlation between the number of positive Delphian lymph nodes and the rate of paratracheal and lateral cervical lymph node metastasis in the central region was analyzed, and the correlation between the Delphian lymph node metastasis and the lymph node metastasis in the ipsilateral and contralateral regions of the tumor was also studied. Results: in this study, Delphian lymph node metastasis and age (P < 0. 005), maximum tumor diameter (P < 0.001), and lymph node metastasis (P < 0. 005). There were significant differences in invasion of membrane (P < 0.05) and Hashimoto's thyroiditis (P < 0.05). There was no significant difference between them and other clinical features. Multivariate logistic regression analysis showed that the maximum diameter of the tumor was more than 1cm, the P value of invading thyroid capsule was < 0.001,0.038, OR value was 4.895, 2.563, and 95% confidence interval was 2.401 ~ 9.981,1.055 ~ 6.226, respectively (P < 0.001, P = 0.038, OR = 4.895,2.563,95% CI = 2.401 ~ 9.981, 1.055 ~ 6.226, respectively). The correlation coefficient between the paratracheal lymph node metastasis rate and the number of Delphian lymph node metastasis in the central region was 1.000 (P < 0.01), and the Kendall correlation coefficient between the lateral neck lymph node metastasis rate and the number of Delphian lymph node metastasis was 0.714, the correlation coefficient was 1.000 (P < 0.01). The correlation coefficient of Spearman was 0.739, P < 0.01; The lymph node metastasis rate in both the affected side and the contralateral part 鈪

本文編號：2433666