郑健玲+陈琼瑶+姚志勋

摘 要 目的：探讨常规超声联合CT对甲状腺乳头状癌颈淋巴结转移的诊断价值。方法：回顾性分析2012年2月至2014年2月期间我院术后病理组织学确诊为甲状腺乳头状癌患者病例141例，分成试验组（51例，常规超声联合CT检查）、CT对照组（45例，单纯CT检查）和US对照组（45例，单纯超声检查），比较三种方法在甲状腺乳头状癌颈淋巴结转移诊断中各自的价值。结果：试验组行单侧颈部淋巴结清扫术48例，双侧颈部淋巴结清扫术3例，共采集预测转移阳性颈淋巴结226枚。诊断准确率CT对照组为43.90%、US对照组为58.14%、试验组为70.59%，试验组明显高于CT与US对照组（P<0.05）；试验组Ⅰ-Ⅵ区转移阳性颈淋巴结的诊断阳性率明显高于对照组（P<0.05）。结论：常规超声联合CT检查可显著改善甲状腺乳头状癌颈淋巴结转移的诊断准确度，值得临床进一步实践。

关键词 常规超声 CT 甲状腺乳头状癌 淋巴结转移

中图分类号：R736.1 文献标识码：A 文章编号：1006-1533（2016）15-0049-05

The value of conventional ultrasonography combined with CT in diagnosis of papillary thyroid carcinoma with cervical lymph node metastasis*

ZHENG Jianling**， CHEN Qiongyao， YAO Zhixun

（The Peoples Hospital of Chaoyang District in Shantou City， Shantou 515100， China）

ABSTRACT Objective： To study the value of conventional ultrasonography combined with CT in diagnosis of papillary thyroid carcinoma （PTC） with cervical lymph node metastasis. Methods： The data from 141 PTC patients diagnosed by postoperative histopathology were retrospectively analyzed and the patients were divided into an experimental group （51 cases， examined with conventional ultrasonography combined with CT）， a CT control group （45 cases， examined only with CT） and a US control group （45 cases， examined only with conventional ultrasonography） and their values in the diagnosis of PTC with lymph node metastasis were compared. Results： There were 48 cases undergoing unilateral neck dissection and 3 cases undergoing bilateral neck dissection and a total of 226 pieces of the predicted positive cervical lymph node metastasis were collected in the experimental group. The diagnostic accuracy was 43.90% in the CT control group， 58.14% in the US control group and 70.59% in the experimental group and was significantly higher in the experimental group than the other two groups（P<0.05）.The positive rate diagnosed as PTC metastasis inⅠ～ Ⅵ zone was significantly higher in the experimental group than the other two groups （P<0.05）. Conclusion： Conventional ultrasonography combined with CT can significantly improve the diagnostic accuracy of PTC with cervical lymph node metastasis and is worthy of further clinical practice.

KEY WORDS conventional ultrasonic； CT； diagnosis； papillary thyroid carcinoma； lymph node metastases

甲状腺乳头状癌（papillary thyroid carcinoma，PTC）是最常见的甲状腺恶性肿瘤，约占全部甲状腺癌的80%[1]。颈淋巴结转移是PTC患者最为主要的转移方式，目前对于颈淋巴结阳性患者实施甲状腺根治术联合颈部淋巴结清扫术尚无异议，但对于颈淋巴结阴性患者是否实施颈部淋巴结清扫术及其手术时机、范围等问题尚存在明显的争议[2]。2012年国内“甲状腺结节和分化型甲状腺癌的诊治指南”中已明确提出对全部分化型甲状腺癌行预防性清扫病灶同侧第六组淋巴结。超声是术前评定甲状腺乳头状癌颈淋巴结转移的主要检查手段，但尚缺乏“每水平”为视角作分析研究。本研究通过探讨常规超声联合CT对甲状腺乳头状癌颈淋巴结转移的诊断价值，以指导甲状腺乳头状癌颈淋巴结转移患者治疗方案的制定。……