有周围侵袭的高分化甲状腺癌的外科治疗

Operation for well-differentiated invading thyroid carcinoma

目的分析有周围侵犯的高分化甲状腺癌的外科治疗,总结其临床经验。方法回顾性分析1984—2000年在辽宁省肿瘤医院进行手术治疗,周围有侵犯的高分化甲状腺癌患者201例的临床资料。生存统计采用Kaplan-Meier法,组间比较采用Log-Rank检验,多因素分析采用Cox模型。结果喉全切和颈段部分气管切除3例,气管部分切除6例,喉、气管表面剔除67例,喉返神经切除9例,喉返神经表面剔除26例,包括带状肌、胸锁乳突肌、颈内静脉、迷走神经等周围软组织切除90例。201例中合并食管受累肌层切除19例,局部拉拢缝合,其中4例用胸锁乳突肌、2例用胸大肌瓣局部加固修补。甲状腺一侧叶及峡部切除189例,一侧腺叶及对侧次全切除5例,甲状腺全切除7例。颈清扫术129例(双颈清扫5例),共134侧,其中经典性颈清扫75侧,改良性颈清扫59侧。5年生存率为85·6%,10年生存率为77·3%,15年生存率为69·4%。经Cox模型分析显示年龄、肿瘤侵犯部位是影响预后的独立因素。结论有周围侵袭的高分化甲状腺癌经过恰当的外科治疗,可以取得较好的疗效。

Objective To analyze the surgical data of well-differentiated invading thyroid carcinoma （WITC） , for acquiring the clinical experience. Methods A retrospective analysis was made in 201 cases with well-differentiated invading thyroid carcinoma in Liaoning Tumour Hospital from 1984 to 2000. The data were statistically treated for survival curves according to the Kaplan-Meier method. The Log-Rank tests were employed to assess the statistical significance of various groups. Results There were 3 cases with total laryngectomy and partial cervical trachea resection, 6 cases with partial cervical trachea resection, 67 cases with shaving off tumor from its surface, 9 cases with recurrent laryngeal nerve resection, 26 cases with shaving off tumor from the surface of recurrent laryngeal nerve. Other local structures invaded in 90 cases was resected with the thyroid turnout en bloc. One hundred and eighty nine cases with one thyroid lobe and isthmus gectomy, 5 cases one lobe and obsite subtotall gectomy. One hundred and twenty nine cases simutenous neck dissection（ 5 cases bilateral neck dissection）, in them, 75 neck radical neck dissection, 59 neck modified dissection. The 5-, 10- and 15-year living rates of well-differentiated thyroid carcinoma patients were 85.6% ,77.3% and 69.4% respectively. Multivariate analysis showed that patients＇age, tumour invading structure were independent prognostic factors. Conclusions With proper operation, a better cure will be made in WITC.