分化型甲状腺癌合并桥本甲状腺炎的临床特征及不同手术方式探讨

Clinical characteristics and different surgical methods of differentiated thyroid cancer with Hashimoto’s thyroiditis

目的分析分化型甲状腺癌(DTC)合并桥本甲状腺炎(HT)的临床特征,比较不同手术方式的疗效。方法回顾性分析2018年1月至2019年5月辽宁省肿瘤医院初治的692例DTC患者的资料,按照是否合并HT分为DTC组(n=485)和DTC合并HT(DTC-HT)组(n=207),比较两组临床特征和术后并发症的差异。结果两组在性别、微小癌、多发灶、甲状腺侵犯、颈淋巴结转移、再次手术、甲状腺过氧化物酶抗体方面差异有统计学意义(P<0.05)。DTC-HT组无血流信号比例高于DTC组,差异有统计学意义(47.8%vs 39.0%,χ^(2)=4.684,P=0.030)。DTC-HT组中甲状腺全切和非甲状腺全切患者术后第1天引流量、一过性低钙血症及暂时声音嘶哑发生率差异无统计学意义(P>0.05)。结论DTC合并HT患者以女性居多,多为微小癌,具有多发灶的特点,且术后残余腺体易发现新的癌灶,常需二次手术,应有计划地进行甲状腺全切除加患侧中央区淋巴结清扫术。

Objective To explore the clinical characteristics of differentiated thyroid cancer(DTC)combined with Hashimoto s thyroiditis(HT),and to compare the efficacy of different surgical methods.Methods A retrospective analysis was conducted on data from 692 patients with DTC initially treated at Liaoning Cancer Hospital&Insititute from January 2018 to May 2019.The patients were divided into DTC group(n=485)and DTC combined with HT(DTC-HT)group(n=207).Clinical characteristics and postoperative complications were compared between two groups.Results There were statistically significant differences between two groups in terms of gender,microcarcinoma,multifocality,thyroid invasion,neck lymph node metastasis,reoperation,and thyroid peroxidase antibody(P<0.05).The proportion of patients with no blood flow signal in the DTC-HT group was higher than that in the DTC group(47.8%vs 39.0%,χ^(2)=4.684,P=0.030).There was no statistically significant difference in drainage volume at the first day after operation,transient hypocalcemia,and temporary hoarseness between total thyroidectomy and non-total thyroidectomy patients in the DTC-HT group(P>0.05).Conclusion Patients with DTC combined with HT often present with microcarcinomas and multifocality,mainly females.After surgery,residual thyroid tissue may reveal new lesions,often necessitating a second surgery.Planned total thyroidectomy with ipsilateral central lymph node dissection should be considered.