The Clinical Analysis Of Influencing Factors Of Level Ⅱ Lymphatic Metastasis In 57 Papillary Thyroid Carcinoma Cases

Objectives:Papillary thyroid carcinoma(PTC)is the most common pathological type of thyroid carcinoma with a good prognosis,but it is prone to lymph node metastasis,and there is controversy about the extent of lymph node dissection in the neck,especially the level Ⅱ lymph node.This article analyzes the factors affecting lymph node metastasis in the cervical level Ⅱ of papillary thyroid carcinoma and provides a basis for the clinical treatment of cervical lymph node dissection in papillary thyroid carcinoma.Methods:To retrospectively analyze the clinical data of patients undergoing thyroidectomy + central lymph node dissection + lateral cervical lymph node dissection in the Department of Breast and Thyroid Surgery of Shandong Province Qianfoshan Hospital from January 2015 to December 2017.The relationship between gender,age,size of the tumor,whether the tumor invaded into the capsule,whether it was unilateral leaf multifocal,whether it was bilateral foci lesions,whether there was metastasis in the central lymph node,and whether there was metastasis in the level Ⅱ lymph nodes.Results:①A total of 57 patients in this study,postoperative pathology confirmed as papillary thyroid carcinoma.16 males and 41 females,male to female 1:2.56;age 19-88 years old,the median age of 44 years old;tumor diameter 0.1cm-4.5cm,the average tumor diameter of 1.3cm;39 cases of tumor invading the capsule,18 cases without invading the capsule;12 patients had multiple lesions with unilateral lobes and 45 with unilateral lobes or bilateral lobes;15 patients had bilateral lesions and 42 had unilateral lesions.②There were 48 cases in the levelⅥ with positive lymph node metastasis in all 57 patients,32 cases in the level Ⅱ,38 cases in the levelⅢ,32 cases in the levelⅣ.There were 37 cases of lymph node dissection in level Ⅴ and 8 cases of positive lymph node metastasis.The overall rate of lymph node metastasis were levelⅥ84.2%(48/57),level Ⅱ 56.1%(32/57),levelⅢ66.7%(38/57),levelⅣ56.1%(32/57),levelⅤ21.6%(8/37).③In this group of patients with gender,age,size of tumor lesions,whether the invasion of the capsule,multiple unilateral lesions and lesions were not observed with the level Ⅱ lymph node metastasis statistical significance(P>0.05).④The data of this group of patients were observed in the central lymph node metastasis is an important influencing factor of lymph node metastasis(P<0.05).⑤Patients with bilateral lesions have lesions in both central lymph node metastasis and lymph node metastasis of the level Ⅱthere was a significant difference(P<0.05).Conclusion:①Clinical lymph node metastasis(clinically positive neck,cNl)PTC cervical lymph node metastasis has a certain law,leve1Ⅵ up 84.2%,followed by 66.7%of the levelⅢ,levelⅣ56.1%.levelⅡ56.1%,levelⅤ minimum 21.6%.②LevelVI lymph node metastasis is an important factor affecting the metastasis of the lateral cervical lymph nodes.③For cNl patients with PTC,if the lesion involves bilateral lobes,there is metastasis to the levelVI lymph node,and level Ⅱ should be included in lateral cervical lymph node dissection.It provides a certain basis for the selection of cervical lymph node dissection and clinical individualized treatment of cervical lymph node dissection in papillary thyroid carcinoma.