Ⅰ、Ⅱ期甲状腺乳头状癌手术方式对预后影响因素分析

The retrospective analysic of clinical effects of different surgical treatments in stage Ⅰ,Ⅱ Papillary thyroid carcinoma

目的探讨Ⅰ、Ⅱ期甲状腺乳头状癌不同手术方式对预后的影响,以选择合适的手术方式。方法回顾性分析新疆医科大学第一附属医院1998年1月-2010年12月经纳入标准筛选的247例Ⅰ、Ⅱ期甲状腺乳头状癌患者的临床资料,根据手术方式的不同分为3组:患侧腺叶加峡部切除术组(A组),患侧腺叶全切加对侧腺叶大部(次全)切除术组(B组),甲状腺叶全切除术组(C组)。比较3组不同手术方式下患者淋巴转移、复发及并发症情况。结果Ⅰ期甲状腺乳头状癌,A、B、C组之间在淋巴转移及复发差别无统计学意义(P>0.05);A组与B、C组在声嘶差异比较有统计学意义(P<0.05);A、B组与C组在甲状旁腺功能减退差别有统计学差异(P<0.05)。Ⅱ期甲状腺乳头状癌,A组与B、C组在淋巴转移及复发差别上有统计学意义(P<0.05);B、C组在淋巴转移、复发差别上无统计学意义(P>0.05)。A、B、C组在术后声嘶及甲状旁腺功能减退差异均无统计学意义(P>0.05)。结论Ⅰ期甲状腺乳头状癌,行患侧腺叶加峡部切除术是一种合理的手术方式。Ⅱ期甲状腺乳头状癌,甲状腺全切除术可以减少术后复发及转移。

Objective Analysis of papillary thyroid carcinoma （PTC） of different operations on the impact of long-term complications, surgical treatments in order to find the most reasonable way. Methods Ret-rospective analysis of the clinical information of PTC patients in Ⅰ , Ⅱ stage hospitalized in the First Affil-iated Hospital of Xinjiang Medical University from 1998 to 2012. According to different inclusion criteria selected, 247 cases of stage Ⅰ and ⅡPTC were divided 3 groups. A group of patients were taken gland lo-bectomy plus the gland isthmus resection; B group were taken thyroid lobe resection, isthmus total resec-tion and contralateral subtotal operation; C group were performed total thyroidectomy. Lymph node me- tastasis, recurrence and complications were measured. Their surgical methods and postoperative complica-tionsin the relationship between were analyzed statistically. Results The statistical analysis showed that Lymph node metastasis, recurrence rate and complications are closely related with different operations. In stage Ⅰ PTC, there was no significant difference in recurrence, lymphatic metastasis among 3 surgical groups （P 〉0.05） ; Complications of A group had significant difference with B group and C group （P 〈0.05）. In stage Ⅱ PTC, Lymph node metastasis and recurrence rate of A group had significant difference with B group and C group （P 〈0.05）. There were no significant difference in recurrence, lymphatic me-tastasis and complications in B group with C group （P〉0.05）. Conclusion For stage Ⅰ patients, gland lobectomy plus the gland isthmus resection is the best choice. For stage Ⅱ patients, total thyroidectomy can give patients hope for cure to reduce the postperative recurrence and metastasis.