甲状腺癌不规范手术后再手术相关问题的探讨

Re-operation for thyroid carcinoma patients who received nonstandard operation

目的 了解甲状腺癌再手术患者的生存情况,制定再手术的适应证,选择相应的手术方式。方法 总结1986-1997年间在其他院行甲状腺癌切除术后又到中山大学肿瘤防治中心行第二次手术治疗的111例甲状腺癌患者的临床资料,分析手术情况并术后随访资料进行统计学分析。结果 病理检查证实再手术患者肿瘤残留率为67.6％(75/111);并发症发生率2.7％(3/111),其中喉返神经损伤率0.9％(1/111)。术前CT检查发现肿瘤残留的灵敏度为80.0％(28/35),阳性预测值为87.5％(28/32)。3年复发率为11.7％(13/111),局部控制率为88.3％(98/111);5年复发率14.4％(16/111),局部控制率为85.6％(95/111)。采用寿命表法计算生存率,甲状腺癌再手术患者5年累计生存率为95.0％;10年累计生存率为93.2％。多因素分析(Cox回归)证实肿瘤复发对生存情况的影响有统计学意义。结论 甲状腺癌不规范手术的肿瘤残留率较高,慎重的再手术是必要的。CT检查对于发现肿瘤残留有较高的阳性预测值,对于筛选再手术患者有重要意义。复发是影响再手术患者生存的主要因素;按适应证选择手术病例,可以使不必要再手术的患者免受手术之苦。

Objective To analyze the reasons for re-operation and living condition of thyroid carcinoma patients who received second operation, and to formulate indications for selecting re-operation candidates and operation types. Methods One hundred and eleven thyroid carcinoma patients were retrospectively summarized. All patients received re-operation after thyroidectomy from 1986 to 1997. The post operative follow-up data were analyzed statistically. Results Pathological results confirmed there were 67. 6% (75/111) cases with residual tumor. The incidence rate of post-operative complications was 2. 7% , including 0.9% (1/111) recurrent laryngeal nerve injury. The sensitivity of residual carcinoma detection by CT scan before operations was 80. 0% (28/35) , with the positive predictive value of 87. 5% (28/32). The recurrence rate within 3 years was 11.7% (13/111), with a local control rate of 88. 3% (98/111). The recurrence rate within 5 years was 14. 4% ( 16/111 ) , with a local control rate of 85. 6% (95/111). Life table was adopted to calculate living rates. The accumulated 5-year and 10-year living rates of re-operated thyroid carcinoma patients were 95. 0% and 93. 2% respectively. Analysis of Cox Regression showed that carcinoma recurrence influenced survival conditions significantly. Conclusions The residual rate of re-operated patients with thyroid carcinoma was relatively higher, so a cautious re-operation was necessary. CT scan has a relatively higher positive predictive rate in detecting residual carcinoma, so it is necessary for screening right candidates for re-operation. Recurrence was the main factor that influenced patients' survival. So making proper indications, according to which to select patients who need re-operations will decrease the incidence of unnecessary operations.