不同手术方式治疗分化型甲状腺癌的临床疗效及其影响因素

Clinical Efficacy and Influencing Factors of Differentiated Thyroid Cancer

目的 探究不同手术方式在分化型甲状腺癌治疗中的临床疗效及其影响因素。方法 选择分化型甲状腺癌患者130例,依据手术方式的不同分为全切组(行甲状腺全切术)及次全切组(患侧甲状腺叶及峡部切除术),各65例。比较2组临床疗效、并发症发生率。对所有患者进行1年的随访,根据随访结果分为有进展生存组及无进展生存组,并分析影响分化型甲状腺癌患者治疗效果的相关因素。结果 2组临床疗效比较,差异无统计学意义(P>0.05);次全切组发音困难、喉返神经损伤发生率低于全切组,差异有统计学意义(P<0.05);2组手足麻木、暂时性喉返神经麻痹发生率比较,差异无统计学意义(P>0.05)。随访1年,无进展生存有92例(无进展生存组),有进展生存38例(有进展生存组)。全切组无进展生存率为80.00%(52/45),高于次全切组的61.53%(40/65),差异有统计学意义(P<0.05)。有进展生存组肿瘤直径≥3 cm、滤泡型甲状腺癌、TNM分期Ⅳ期、淋巴结转移占比率均高于无进展生存组,差异有统计学意义(P<0.05);肿瘤直径≥3 cm、滤泡型、TNM分期、淋巴结转移是影响分化型甲状腺癌患者手术效果的独立危险因素(P<0.05)。结论 分化型甲状腺癌患者采用甲状腺全切术治疗可获得确切的临床效果,有助于提高无进展生存率,降低复发及转移率。肿瘤直径、滤泡型甲状腺癌、TNM分期、淋巴结转移是影响分化型甲状腺癌术后的独立危险因素。

Objective To explore the clinical efficacy and influencing factors of different surgical methods in the treatment of differentiated thyroid cancer.Methods 130 patients with differentiated thyroid cancer were divided into total resection(total thyroectomy) group and subtotal resection group(thyroid lobe and isthmectomy of the affected side),65 cases in each group.Clinical efficacy and complication rate were compared.All patients were followed up for 1 year and divided into progression survival and progression-free survival groups according to the follow-up results, and analyzed the related factors affecting the treatment effect of patients with differentiated thyroid cancer.Results The clinical efficacy(P>0.05);the incidence of pronunciation and recurrent laryngeal nerve injury was lower than that(P<0.05);the incidence of numbness and paralysis(P>0.05).At 1 year of follow-up, there were 92 progression-free survival patients(progression-free survival group) and 38 progressive survival patients(progressive survival group).The progression-free survival rate in the total cut group was 80.00%(52/45),which was higher than 61.53%(40/65) in the subtotal cut group, which was statistically significant(P<0.05).In progressive survival group, tumor diameter of 3 cm, follicular thyroid cancer, TNM stage and lymph node metastasis were higher than those in progression-free survival group(P<0.05);tumor diameter of 3 cm, follicular type, TNM stage and lymph node metastasis were independent risk factors affecting the surgical effect of differentiated thyroid cancer patients(P<0.05).Conclusion The differentiated thyroid cancer patients are treated with the exact clinical effect, which can help improve the progression-free survival rate and reduce recurrence and metastasis rate;tumor diameter, follicular thyroid cancer, TNM stage and lymph node metastasis are independent risk factors affecting the differentiated thyroid cancer after surgery.