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目的:探讨影响甲状腺微小癌(TMC)颈淋巴结转移的危险因素以及颈淋巴结清扫的范围。方法:回顾性分析2009年1月—2013年6月收治的269例TMC患者资料,患者均在原发灶根治的同时行中央区淋巴结清扫,27例患者行颈侧区淋巴结清扫,分析患者各临床病理因素与颈淋巴结转移的关系。结果:269例患者中107例(39.8%)发生颈淋巴结转移,其中中央区淋巴结转移103例(96.3%),颈侧区淋巴结转移25例(23.4%)。单因素分析显示,男性、肿瘤直径>5.0 mm、包膜侵犯与TMC颈淋巴结转移有关(均P<0.05);多因素分析显示,肿瘤直径>5.0 mm(OR=3.358,P<0.05)、包膜侵犯(OR=5.230,P<0.05)是颈淋巴结转移的独立危险因素。结论:对于肿瘤直径>5.0 mm或有包膜侵犯的TMC患者,中央区淋巴结转移的几率增加,行中央区淋巴结清扫是必要的。
Objective: To explore the risk factors affecting cervical lymph node metastasis of thyroid microcarcinoma (TMC) and the range of cervical lymph node dissection. Methods: The data of 269 patients with TMC admitted from January 2009 to June 2013 were retrospectively analyzed. All the patients underwent radical lymphadenectomy while the radical lymph node dissection was performed in 27 cases. The patients’ Relationship between clinicopathological factors and cervical lymph node metastasis. Results: Of the 269 patients, 107 (39.8%) had cervical lymph node metastases, including 103 (96.3%) lymph node metastases in the central region and 25 (23.4%) cervical lymph node metastases. Univariate analysis showed that in men, the diameter of tumor> 5.0 mm and the invasion of capsule were related to cervical lymph node metastasis of TMC (all P <0.05). Multivariate analysis showed that tumor diameter> 5.0 mm (OR = 3.358, P <0.05) Membranous invasion (OR = 5.230, P <0.05) was an independent risk factor for cervical lymph node metastasis. Conclusion: For TMC patients with tumor diameter> 5.0 mm or with encroachment, the probability of lymph node metastasis in the central area increases, and lymph node dissection in the central area is necessary.