分化型甲状腺癌的治疗及影响复发的因素分析

Surgical Treatment of Differentiated Thyroid Carcinoma and Analysis of Recurrence-related Factors

背景与目的:有关分化型甲状腺癌的治疗,目前仍存在不少争论,争论的焦点主要包括分化型甲状腺癌外科切除的合适范围、颈淋巴结清扫的适应证等。本文主要研究分化型甲状腺癌的外科治疗及影响其复发的因素。方法:回顾性分析1985年1月1日～1997年12月31日在中山大学肿瘤防治中心治疗的分化型甲状腺癌581例,研究分化型甲状腺癌的治疗方式和效果,分析影响其复发的因素。结果:在我院行首次手术治疗、以单侧腺叶加峡部切除术加或不加颈淋巴结清扫为主要治疗方式的377例分化型甲状腺癌中,28例复发,复发率为7.43%,对侧腺叶的复发率为0.80%。在外院行首次手术治疗、以局部肿物切除加或不加颈淋巴结切除为主要治疗方式的195例分化型甲状腺癌中,143例再行手术治疗,100例再次术后病理阳性,肿瘤残留率为69.93%,其中腺体阳性率为46.15%,颈淋巴结阳性率为48.95%,195例中有47例复发,复发率为24.10%。以局部肿物切除加或不加颈淋巴结切除为主要治疗方式的患者的复发率显著高于以单侧腺叶加峡部切除加或不加颈淋巴结清扫为主要治疗方式的患者(P<0.05)。结论:单侧腺叶加峡部切除术加或不加颈淋巴结清扫应作为原发灶局限于一侧腺叶的分化型甲状腺癌的首次手术治疗方式。首次手术方式影响分化型甲状腺癌的复发。

BACKGROUND &OBJECTIVE: There are many controversies concerning the treatment to patients with differentiated thyroid carcinoma (DTC), focus on appropriate resection extent of DTC, indications for cervical lymph node dissection, et al. This study was to investigate surgical treatment for DTC, and recurrence related factors. METHODS: Records of 581 patients with DTC treated at Cancer Center, Sun Yat sen University from Jan. 1st, 1985 to Dec. 31st, 1997 were reviewed retrospectively. Various operation patterns for DTC and their treatment effects, and recurrence related factors were analyzed. RESULTS: Among 377 patients with DTC who received initial surgery at our hospital, and whose main operation patterns were unilateral lobectomy plus isthmectomy with or without cervical lymph node dissection, 28 (7.43%) recurred, the rate of recurrence in contralateral lobe was 0.80%. Among 195 patients with DTC who received initial surgery in other hospitals, and whose main operation patterns were local mass excision with or without cervical lymph node resection, 143 patients received operation again in our hospital, and 100 of 143 (69.93%) were pathologic positive, positive rate of thyroid was 46.15%, that of cervical lymph node was 48.95%; 47 of 195 patients (24.10%) recurred. Recurrence rate of patients mainly received local mass excision with or without cervical lymph node resection was higher than that of patients mainly received unilateral lobecomy plus isthmectomy with or without cervical lymph node dissection (P >0.05). CONCLUSIONS: Unilateral lobectomy plus isthmectomy with or without cervical lymph node dissection should be recommended as the first treatment for DTC with primary focus localized in unilateral lobe. The initial operation pattern may influence recurrence of DTC.