乳头状甲状腺癌预防性颈部中央区淋巴结清扫对复发率的影响

Effect of prophylactic central neck dissection on recurrece rate for papillary thyroid carcinoma

目的:探讨预防性中央区淋巴结清扫对乳头状甲状腺癌复发率的影响。方法:回顾性分析本院2003年1月至2011年12月经病理证实为乳头状甲状腺癌并行手术+131I治疗的患者283例,其中行甲状腺全切术113例(TT组),全切术+预防性中央区淋巴结清扫术170例(TT+PCND组),比较两组接受131I剂量、复发率、术后永久性并发症发生率等指标。使用单变量分析方法,分析各因素对肿瘤复发率的影响。结果:两组患者在年龄、性别、肿瘤大小、肿瘤性质等方面都无明显差异,术后随访中,TT组复发21例,再手术17例,TT+PCND组复发15例,再手术7例,TT+PCND组复发率明显低于TT组(P=0.018)。而两组在131I积累量、术后永久性甲状旁腺减退和神经麻痹上,差异无统计学意义。单变量分析也证明预防性中央区淋巴结清扫是唯一减少乳头状甲状腺癌复发的因素(优势比=0.4)。结论:对乳头状甲状腺癌患者,行PCND处理可有效降低肿瘤复发率,且不增加永久性并发症的几率,可提高患者生活质量。

Objective： To evaluate the effect of prophylactic central neck dissection（ PCND） on recurrece rate for the papillary thyroid carcinoma. Methods： All 283 patients with papillary thyroid carcinoma proved by pathological findings received operation and radioactive iodine,113 of them were treated with thyroidectomy（ TT group）,and another 170 patients were treated with TT and PCND（ TT ＋ PCND group）,compared the cumulative dose of131 I,recurrece rate,permanent complications after the surgery. Univariate analysis was used to analyze the factors influencing the rate of recurrece. Results： The two groups were similar in age,gender,tumor size and tumor characteristic. During the follow-up,21 cases recurrce and 17 patients received reoperation in TT group versus 15 and 7 in the TT ＋ PCND group,there were no other statistical differences between the two groups. Univariate analysis also proved PCND was the only factor to decrease the recurrece rate（ Odds Ratio = 0. 4）. Conclusion： PCND could decrease the recurrece rate but did not increace permanent complications for the papillary thyroid carcinoma patients.