张毅 董剑达 季敬章 郑志强

[摘要] 目的 探讨超声（ultrasound，US）联合计算机断层扫描（computed tomography，CT）对甲状腺乳头状癌颈淋巴结转移的临床诊断价值。 方法 选取2013年6月～2015年6月在我院行甲状腺癌手术治疗、术后病理证实为甲状腺乳头状癌98例，术前均行颈部B超和CT检查，术后行HE染色、组织病理检查，进行相互比较。 结果 根据“每水平”分析，US/CT与US相比能显著提高颈侧区和颈总区转移淋巴结的检测准确度（P=0.032，P=0.028）；US/CT与CT相比并未能显示出优越的诊断价值（P>0.05）。根据“每人”分析，US与CT的准确率比较差异无统计学意义（P>0.05）；US/CT与US之间的准确率比较差异有统计学意义（P=0.047）；而US/CT与CT之间的准确率比较差异无统计学意义（P>0.05）。影像学预测转移组与未转移组准确率对比，差异有统计学意义（P<0.05）。 结论 US/CT对PTC患者颈侧区转移淋巴结的检测优于US，对术前US怀疑有颈侧区淋巴结转移者，可进一步行CT检查，以决定是否行颈侧区淋巴结清扫。

[关键词] 甲状腺乳头状癌；淋巴结转移；超声；计算机断层扫描

[中图分类号] R576 [文献标识码] B [文章编号] 1673-9701（2015）34-0092-04

Clinical value of combined ultrasound and CT for detecting cervical metastatic lymph nodes in patients with papillary thyroid carcinoma

ZHANG Yi1 DONG Jianda1 JI Jingzhang2 ZHENG Zhiqiang1

1.Department of General Surgery， the Second Affiliated Hospital of Wenzhou Medical College， Wenzhou 325000， China； 2.Wenzhou Medical College， Wenzhou 325000， China

[Abstract] Objective To explore the value of ultrasonography and CT in diagnosis of the cervical lymph nodes metastasis of thyroid carcinoma. Methods From June 2013 to June 2015， 98 cases of thyroid cancer patients were selected as the research object patients， who confirmed as papillary thyroid carcinoma by pathology. All patients were evaluated by ultrasonography and CT examination before surgery. And then examined by pathologicl HE staining and pathology method after operation. Results The accuracy of detection of metastatic nodes by US/CT was higher than By US at the level of central and lateral neck with “per level” analysis （P=0.032 and P=0.028）. Detected by US/CT was no significant difference of diagnostic values than by CT. With “per person” analysis， there were no significant differences of accuracy between US and CT or between US/CT and CT （P>0.05）. Compared with the group without metastasis， the accuracy of the imaging prediction was statistically significant（P<0.05）. Conclusion US/CT combination is found to be superior to US alone for the detection of cervical metastatic lymph nodes in lateral neck levels in PTC patients. Preoperative CT should be used in some PTC patients with suspected node metastasis by US， and to determine whether the lateral compartment dissection is needed.

[Key words] Papillary thyroid carcinoma； Lymph nodes metastasis； Ultrasound； CT

甲状腺乳头状癌（papillary thyroid carcinoma，PTC）是甲状腺最为常见的恶性肿瘤，约占所有甲状腺癌的80%[1-4]，颈淋巴结转移是PTC最主要的转移方式，目前对颈淋巴结阳性（cN+）病例实行联合根治手术已无异议，但对临床颈淋巴结阴性（cN0）的病例，是否实行颈部淋巴结清扫以及清除范围、时机等问题国内外均存在争议。超声是目前术前评估甲状腺癌淋巴结转移情况的首选方法[5]，然而大部分这些报道主要根据“每人”的视角，而不是以“每水平”为基础作分析研究[6-9]。本实验通过比较甲状腺乳头状癌颈部淋巴结转移的B超和CT的表现，探讨B超联合CT对甲状腺乳头状癌颈淋巴结转移的临床诊断价值，现报道如下。