Page 65 - 南京医科大学学报自然科学版

第43卷第12期 南京医科大学学报（自然科学版）
2023年12月 Journal of Nanjing Medical University（Natural Sciences） ·1681 ·

·临床研究·

645例初治甲状腺乳头状癌患者气管周围淋巴结转移的危险因

素分析

辅 容 ，陆 辉 ，杭 菁 ，施杲旸 1*
1
2
1
南京医科大学第一附属医院普外科，超声诊断科，江苏 南京 210029
1 2

［摘 要］ 目的：评估并分析甲状腺乳头状癌气管周围淋巴结转移相关危险因素，以及喉前淋巴结对气管周围淋巴结转移的
预测能力。方法：回顾性分析本院645例因甲状腺乳头状癌行手术治疗的患者资料。按照中国甲状腺癌诊疗指南（2022年版）
推荐的手术指征和切除范围，根据术前触诊、超声检查和穿刺病理的结果行甲状腺切除和淋巴结清扫术。结果：645例中，215例
（33.3%）术后病理证实气管周围淋巴结转移。单因素分析提示气管周围淋巴结转移与年龄<45岁、癌灶最大径≥1 cm、腺内播
散、腺外侵犯、多发灶、癌灶累及双叶、喉前淋巴结转移有关。多因素分析提示年龄<45岁、喉前淋巴结转移是气管周围淋巴结
转移的独立危险因素。喉前淋巴结转移对气管周围淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为
21.4%、93.7%、63.0%、70.5%、69.6%。结论：在年轻、喉前淋巴结转移的甲状腺乳头状癌患者中要仔细评估气管周围淋巴结情
况。喉前淋巴结转移对气管周围淋巴结转移有一定预测作用，评估喉前淋巴结有助于制定气管周围淋巴结处理策略，但目前
仍需要更多循证医学证据以帮助临床医生更好地决策。
［关键词］ 甲状腺乳头状癌；喉前淋巴结；气管周围淋巴结；淋巴清扫
［中图分类号］ R736.1 ［文献标志码］ A ［文章编号］ 1007⁃4368（2023）12⁃1681⁃05
doi：10.7655/NYDXBNS20231210

Analysis of risk factors for tracheal lymph node metastasis in 645 patients with newly
diagnosed papillary thyroid carcinoma
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1
2
FU Rong ，LU Hui ，HANG Jing ，SHI Gaoyang 1*
1 Department of General Surgery，Department of Ultrasound Diagnosis，the First Affiliated Hospital of Nanjing
2
Medical University，Nanjing 210029，China
［Abstract］ Objective：To evaluate and analyze the risk factors associated with tracheal lymph node metastasis in patients with
papillary thyroid carcinoma（PTC），as well as the predictive ability of pretracheal lymph node involvement for tracheal lymph node
metastasis. Methods：A retrospective analysis was conducted on the data of 645 patients who underwent surgical treatment for PTC in
our hospital. According to the surgical indications and resection scope recommended in the Chinese Thyroid Cancer Diagnosis and
Treatment Guidelines（2022 edition），thyroidectomy and lymph node dissection were performed based on preoperative palpation，
ultrasound examination，and fine ⁃ needle aspiration biopsy results. Results：Among the 645 cases，215 cases（33.3% ）were
pathologically confirmed to have tracheal lymph node metastasis after surgery. Univariate analysis suggested that tracheal lymph node
metastasis was associated with age <45 years，maximum tumor diameter ≥1 cm，intraglandular spread，extraglandular invasion，

multifocal lesions，involvement of both lobes，and pretracheal lymph node metastasis. Multivariate analysis indicated that age <45 years
and pretracheal lymph node metastasis were independent risk factors for tracheal lymph node metastasis. The sensitivity，specificity，
positive predictive value，negative predictive value，and accuracy of pretracheal lymph node involvement in predicting tracheal lymph
node metastasis were 21.4%，93.7%，63.0%，70.5%，and 69.6%，respectively. Conclusion：In young patients with PTC and pretracheal
lymph node metastasis，careful evaluation of tracheal lymph node status is necessary. Pretracheal lymph node involvement has a certain
predictive role in tracheal lymph node metastasis. Assessing pretracheal lymph nodes can help formulate strategies for managing

［基金项目］ 江苏省卫健委医学科研面上项目（M2022027）
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通信作者（Corresponding author），E⁃mail：376683777@qq.com