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目的:探讨多灶性甲状腺乳头状癌(PTC)的临床病理及颈淋巴结转移特征。方法:回顾性分析2016年6月—2016年10月于郑州大学第一附属医院甲状腺外科行手术治疗并经术后病理证实的323例PTC患者的临床资料,其中多灶性PTC患者148例,单灶性PTC患者175例。结果:多灶性PTC患者与单灶性PTC患者间性别、年龄、癌灶最大径差异无统计学意义(均P>0.05),但前者更易发生颈部中央区淋巴结转移(P<0.001)、颈侧区淋巴结转移(P=0.028)及腺外浸润(P<0.001);多灶性PTC患者中,癌灶数≥3的患者中央区淋巴结转移率(P=0.010)、侧区淋巴结转移率(P=0.018)及腺外浸润的发生率(P=0.020)明显高于癌灶数=2的患者;多因素分析显示,癌灶最大径(P=0.005)及癌灶数量(P=0.006)为多灶性PTC中央区淋巴结转移的独立危险因素。结论:多灶性PTC较单灶性PTC侵袭性强,更易发生转移、浸润,建议选择全甲状腺切除加中央区淋巴结清扫作为标准化手术方式,颈侧区存在可疑肿大淋巴结者应积极行颈侧区淋巴结清扫术。
Objective: To investigate the clinicopathologic and cervical lymph node metastasis of multifocal papillary thyroid carcinoma (PTC). Methods: The clinical data of 323 PTC patients surgically treated in Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University from June 2016 to October 2016 were retrospectively analyzed. 148 patients with multifocal PTC, 175 patients with single focal PTC. Results: There were no significant differences in gender, age and maximum size of tumor between patients with multifocal PTC and patients with single PTC (all P> 0.05). However, the former was more likely to have lymph node metastasis in the central region of the neck (P <0.001) (P = 0.028) and extra-infiltration (P <0.001). In multifocal PTC patients, the central lymph node metastasis rate (P = 0.010), the lateral lymph node metastasis rate (P = 0.018), and the incidence of extranodal invasion (P = 0.020) were significantly higher than those with a foci of 2 (P = 0.006) .Multivariate analysis showed that the maximum diameter of foci (P = 0.005) ) Is an independent risk factor for lymph node metastasis in the multifocal PTC central region. CONCLUSION: Multifocality PTC is more aggressive than single focal PTC and more prone to metastasis and infiltration. It is suggested that total thyroidectomy plus central lymph node dissection be used as a standardized surgical approach. Patients with suspicious enlarged lymph nodes in the neck region should be actively treated with cervical spondylosis Regional lymph node dissection.