甲状腺癌诊断及复发因素分析

Analysis on Diagnosis and Relapse Factors of Thyroid Gland Cancer

目的探讨甲状腺癌的诊断及与术后复发有关的因素。方法回顾性分析1999年3月至2006年2月期间上海市第一人民医院宝山分院收治的256例经手术及病理检查证实的甲状腺癌患者的临床资料。结果甲状腺乳头状癌235例(91.8%),滤泡状癌11例(4.3%),髓样癌7例(2.7%),未分化癌3例(1.2%)。所有病例均行手术治疗,手术方式包括:患侧腺叶+峡部+对侧甲状腺腺叶大部切除+病变侧中央区颈淋巴结清扫术;明确颈淋巴结转移或肿块明显外侵者,则行功能性颈淋巴结清扫术;对多灶癌或双腺叶癌者则施行双侧甲状腺全或近全切除,单或双侧Ⅵ区颈淋巴结清扫或一侧功能性颈淋巴结清扫+对侧Ⅵ区颈淋巴结清扫术。228例患者有完整的术后随访资料,随访3～9年,平均随访(6.5±1.3)年。随访期间14例发生复发或转移,其中6例死亡,死亡原因均为术后复发或远处转移。结论影像学检查是诊断甲状腺癌最主要的检查方法,肿块细针穿刺细胞学检查对肿块性质的判断准确率高,可靠性强。淋巴结转移率与原发病灶直径有关,肿瘤病理类型、分期、肿瘤外侵程度、淋巴结转移度、年龄及初次手术方式的选择与术后复发有关。

Objective To explore the diagnosis and relapse factors of thyroid cancer.Methods Two hundreds fifty-six cases of thyroid cancer approved by surgery and pathology from 1999 to 2006 were analyzed retrospectively.Results Two hundred and thirty-five cases were approved papillary thyroid carcinoma（91.8%）,11 cases were follicular thyroid carcinoma（4.3%）,7 cases were medullary thyroid carcinoma（2.7%）,3 cases were anaplastic thyroid cancer（1.2%）.All patients underwent surgery.The operation procedures included thyroidectomy and lymph nodes dissection in central zone of affecting side and subtotal thyroidectomy of contralateral side.Total or subtotal thyroidectomy of both sides and the dissection in unilateral or bilateral Ⅵ region lymph nodes or functional cervical lymph nodes dessection plus contralateral side Ⅵ region lymph nodes dissection in multi-focal cancer and double leaf gland cancer.Functional cervical lymph nodes dessection if existing lymph nodes metastasis or thyroid cancer invading anterior cervical muscle.Two hundreds twenty-eight cases were followed up with complete clinical information about（6.5±1.3） years（3-9 years）.Six cases died during follow-up because of relapse or metastasis.Conclusions Imaging evaluation is the main method for diagnosis of thyroid cancer.Needle biopsy is reliable and accurate for diagnosis of thyroid tumor.Diameter of tumor is related with cervical lymph node metastasis.Patho-type and stage of tumor,local invasion extent,lymph node metastasis and operation procedure are related with the relapse closely.