【摘要】：目的：本文目的是探究影響Delphian淋巴結(jié)的轉(zhuǎn)移情況的臨床因素以及其預(yù)測意義，并且探究Delphian淋巴結(jié)轉(zhuǎn)移規(guī)律對甲狀腺乳頭狀癌臨床診療的指導(dǎo)作用。 方法：回顧性分析2013年9月到2015年1月就診于吉林大學(xué)第一醫(yī)院行手術(shù)治療的探查到Delphian淋巴結(jié)并送檢的182例術(shù)后石蠟病理確診為甲狀腺乳頭狀癌的病例，單因素分析研究相關(guān)臨床因素（包括性別、年齡、腫瘤最大徑，是否多灶，腫瘤是否侵犯甲狀腺被膜、是否合并橋本甲狀腺炎或結(jié)節(jié)性甲狀腺腫或甲狀腺腺瘤以及中央?yún)^(qū)氣管旁淋巴結(jié)和側(cè)頸淋巴結(jié)是否陽性）與Delphian淋巴結(jié)轉(zhuǎn)移情況的相關(guān)關(guān)系，并對有統(tǒng)計學(xué)意義（P＜0.05）的臨床因素進(jìn)行l(wèi)ogistic回歸分析，進(jìn)一步驗(yàn)證各臨床因素的影響。對Delphian淋巴結(jié)的陽性個數(shù)與中央?yún)^(qū)氣管旁淋巴結(jié)及側(cè)頸淋巴結(jié)轉(zhuǎn)移率做相關(guān)性分析，并研究Delphian淋巴結(jié)轉(zhuǎn)移與腫瘤同側(cè)及對側(cè)Ⅵ區(qū)淋巴結(jié)轉(zhuǎn)移情況的相關(guān)性。 結(jié)果：本研究中Delphian淋巴結(jié)轉(zhuǎn)移與年齡（P=0.005）、腫瘤最大直徑（P＜0.001）、是否侵及被膜（P=0.003）以及是否合并橋本甲狀腺炎（P=0.015）的差異有統(tǒng)計學(xué)意義（P＜0.05）；與其他臨床特征差異沒有統(tǒng)計學(xué)意義；多因素logistic回歸分析示腫瘤最大直徑大于1cm，侵及甲狀腺被膜的P值分別為＜0.001、0.038，OR值分別為4.895、2.563，95%的可信區(qū)間分別為2.401~9.981、1.055~6.226；中央?yún)^(qū)氣管旁淋巴結(jié)轉(zhuǎn)移率與Delphian淋巴結(jié)轉(zhuǎn)移的個數(shù)的Kendall相關(guān)系數(shù)與Spearman相關(guān)系數(shù)均為1.000，P＜0.01，，側(cè)頸淋巴結(jié)轉(zhuǎn)移率與Delphian淋巴結(jié)轉(zhuǎn)移個數(shù)Kendall相關(guān)系數(shù)為0.714，Spearman相關(guān)系數(shù)為0.739，P＜0.01；Delphian淋巴結(jié)陽性時患側(cè)與對側(cè)Ⅵ區(qū)的淋巴結(jié)轉(zhuǎn)移率均較高（P＜0.05）。 結(jié)論：Delphian淋巴結(jié)的轉(zhuǎn)移與患者年齡、腫瘤直徑、是否侵犯被膜及被膜外組織以及是否合并橋本甲狀腺炎等因素有關(guān)，腫瘤直徑大于1cm、侵犯甲狀腺被膜是Delphian淋巴結(jié)轉(zhuǎn)移的危險因素；Delphian淋巴結(jié)陽性時中央?yún)^(qū)氣管旁淋巴結(jié)和側(cè)頸淋巴結(jié)轉(zhuǎn)移率分別是Delphian陰性的3倍和1.5倍，并且轉(zhuǎn)移率均與Delphian淋巴結(jié)的陽性個數(shù)呈正相關(guān)；Delphian淋巴結(jié)陽性癌灶同側(cè)及對側(cè)Ⅵ區(qū)的轉(zhuǎn)移率均較高。
[Abstract]:Aim: the purpose of this study is to explore the clinical factors affecting the metastasis of Delphian lymph nodes and its predictive significance, and to explore the role of Delphian lymph node metastasis in the clinical diagnosis and treatment of papillary thyroid carcinoma. Methods: from September 2013 to January 2015, a total of 182 cases of thyroid papillary carcinoma diagnosed as thyroid papillary carcinoma by paraffin-embedded pathology were analyzed retrospectively. The Delphian lymph nodes were detected and examined in the first Hospital of Jilin University from September 2013 to January 2015. Univariate analysis was used to investigate related clinical factors (including sex, age, maximum diameter of tumor, multiple foci, and invasion of thyroid capsule). Whether Hashimoto's thyroiditis or nodular goiter or thyroid adenoma and paratracheal and lateral cervical lymph nodes in the central region were positive) were associated with Delphian lymph node metastasis. The clinical factors with statistical significance were analyzed by logistic regression analysis, and the influence of each clinical factor was further verified. The correlation between the number of positive Delphian lymph nodes and the rate of paratracheal and lateral cervical lymph node metastasis in the central region was analyzed, and the correlation between the Delphian lymph node metastasis and the lymph node metastasis in the ipsilateral and contralateral regions of the tumor was also studied. Results: in this study, Delphian lymph node metastasis and age (P < 0. 005), maximum tumor diameter (P < 0.001), and lymph node metastasis (P < 0. 005). There were significant differences in invasion of membrane (P < 0.05) and Hashimoto's thyroiditis (P < 0.05). There was no significant difference between them and other clinical features. Multivariate logistic regression analysis showed that the maximum diameter of the tumor was more than 1cm, the P value of invading thyroid capsule was < 0.001,0.038, OR value was 4.895, 2.563, and 95% confidence interval was 2.401 ~ 9.981,1.055 ~ 6.226, respectively (P < 0.001, P = 0.038, OR = 4.895,2.563,95% CI = 2.401 ~ 9.981, 1.055 ~ 6.226, respectively). The correlation coefficient between the paratracheal lymph node metastasis rate and the number of Delphian lymph node metastasis in the central region was 1.000 (P < 0.01), and the Kendall correlation coefficient between the lateral neck lymph node metastasis rate and the number of Delphian lymph node metastasis was 0.714, the correlation coefficient was 1.000 (P < 0.01). The correlation coefficient of Spearman was 0.739, P < 0.01; The lymph node metastasis rate in both the affected side and the contralateral part 鈪

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