甲状腺乳头状癌手术切除范围及预后评估

EVALUATION OF RESECTION RANGE AND PROGNOSIS OF PAPILLARY THYROID CARCINOMA

目的 比较不同手术切除范围对甲状腺乳头状癌患者预后的影响.方法 选择2006年4月-2009年4月确诊的Ⅰ、Ⅱ期甲状腺乳头状癌患者112例,随机分为A组和B组,A组56例采用腺叶加峡部切除术,B组56例采用甲状腺全切术,观察比较2组患者的淋巴转移、复发率及并发症情况,以判断预后.结果 Ⅰ、Ⅱ期甲状腺乳头状癌患者的并发症发生率A组明显低于B组,差异有统计学意义（χ2=4.349 5,P＜0.05）.Ⅰ期淋巴转移及复发率A、B组差异无统计学意义;Ⅱ期A组高于B组,差异有统计学意义（χ2=4.301 8,P＜0.05）.结论 腺叶加峡部切除术治疗Ⅰ期甲状腺乳头状癌患者可以减少并发症发生率,而甲状腺全切术治疗Ⅱ期甲状腺乳头状癌患者可以减少淋巴转移及复发率,临床上应根据患者病情选择合适的手术切除范围,以获得最佳的临床预后.

Objective To compare the influence of different resection range on prognosis in patients with papillary thyroid carcinoma. Methods A total of 112 patients with Stage I , Ⅱ papillary thyroid carcinoma from April 2006 to April 2009 were selected and randomly divided into group A and group B. Fifty - six cases of group A were treated with thyroid gland lobectomy plus isthmus resection and 56 cases of group B with total thyroidectomy. The lymph node metastasis, recurrence rate and complications of two groups were observed to determine the prognosis. Results The lymph node metastasis, recurrence rate of stage Ⅱ papillary thyroid carcinoma patients in group A were significantly higher than that of group B, the differences between two groups were statistically significant （ P 〈 0.05 ） ; and the complications of group A were significantly lower than group B, the difference between two groups was statistically significant （P 〈 0.05）. Conclusion Thyriod gland lobectomy plus isthmus resection in the treatment of stage I papillary thyroid carcinoma can reduce the incidence of complications, total thyroidectomy in the treatment of Ⅱ period papillary thyroid carcinoma can reduce the lymph node metastasis and recurrence, it should be based on the clinical condition to choose the right surgery range to obtain the best clinical outcome.