| ObjectiveTo investigate the rules and influencing factors of the lymph node metastasis in papillary thyroid carcinoma,and provide reference for the dissection of cervical lymph node in papillary thyroid carcinoma surgery.MethodsThis study retrospectively analyzed the clinical information of 182 patients who received thyroid cancer surgery for the first time from December 2016 to December 2018 in the second department of general surgery of Qingdao municipal hospital.All patients underwent cervical lymph node dissection,and postoperative paraffin pathology was confirmed as papillary thyroid cancer.According to the presence or absence of lymph node metastasis in the central region and the lateral cervical region,univariate analysis was adopted to study the relationship between gender,age,maximum tumor diameter,number of tumors,preoperative TSH level,outside invasion,as well as lymph node metastasis in the central region and the lateral cervical region.All data were used SPSS19.0 software chi-square test that P<0.05 was considered statistically significant.ResultsAmong the selected 182 patients with papillary thyroid cancer,a total of 72 patients had lymph node metastasis,including 59 patients with lymph node metastasis in the central region and 35 patients with lymph node metastasis in the lateral neck region.Univariate analysis showed that rate of lymph node metastasis in the central thyroid region was higher in papillary thyroid cancer patients with gender,age,tumor diameter,multiple tumors,invasion of the outer thyroid membrane,preoperative TSH level,with statistically signifycant differences(P<0.05).However,there was no significant correlation with nodular goiter,and has himoto’s thyroiditis(P>0.05).A total of 124 cases of single lesions,the central area and the lateral neck lymph node metastasis were 34(27.4%)cases and 17(13.7%)cases,multiple lesions total of 58 cases,the central area and the lateral neck lymph node metastasis were 25(43.10%)and 18(31.03%)cases that multiple foci of lymph node metastasis rate higher than single tumor(P<0.05).A total of 48 cases of male,the central area and the lateral neck lymph node metastasis were 25(52.08%)and 14(29.17%),female134 cases,the central area and the lateral neck lymph node metastasis were 34(25.37%)and21(15.67%),The rate of cervical lymph node metastasis in male patients was significantly higher than that in female patients(P < 0.05).In 134 cases of Tumor diameter ≤l cm,the central area and the lateral cervical lymph node metastasis were 33(24.63%)and 15(11.19%)cases,in 48 cases of tumor diameter>1 cm,the central and lateral neck area lymph node metastasis were 26(54.17%)and 20(41.67%)cases(P<0.05).In 142 cases of Age≤55years.the central area and the lateral cervical lymph node metastasis were 52(36.62%)and22(15.49%)cases,in 40 cases of Age>55 years,the central and lateral cervical area lymph node metastasis were 7(17.5%)and 13(32.5%)cases(P < 0.05).In 121 cases of preoperative TSH level<3.5uu/ml,the central area and the lateral cervical lymph node metastasis were 32(26.45%)and 18(14.88%)cases,in 61 cases of preoperative TSH level≥3.5uu/ml,the central and lateral neck area lymph node metastasis were 27(44.26%)and 17(27.87%)cases(P<0.05).When the central lymph node-negative,the transfer rate of lateral neck metastasis is10.57%(13/123).When the central lymph node-positive.the transfer rate of lateral neck lymph node metastasis is 37.29%(22/59),(P<0.05).ConclusionMan,less than 55 years old,tumor diameter more than 1.0cm,multiple lesions,high TSH level,invasion of the outer membrane were risk factors for central cervical lymph node metastasis while invasion of the outer membrane,central cervical lymph node metastasis were risk factors for lateral cervical lymph node metastasis.The choice of operation for papillary thyroid cancer is closely related to the above factors,suggesting that central lymph node dissection is also recommended regardless of whether lymph node metastasis is found in the patients.For tumors with diameter> 1cm,lymph nodes in the central region of the benign side should be dissected;for patients with thyroid epithelium invasion,lymph nodes in the central region and the lateral neck region should be dissected;for patients with high positive rate of lymph nodes in the central region,attention should be paid to the dissection of lymph nodes in the lateral neck region. |
