不同术式治疗cN_0甲状腺乳头状癌的疗效比较

Outcomes Comparison of cN_0 Thyroid Papillary Carcinoma by Different Operation Methods

目的:比较不同手术方式治疗临床颈淋巴结阴性(cN0)甲状腺乳头状癌(PTC)的效果。方法:选择2010年1月-2012年9月期间在我院治疗的100例cN0PTC患者,随机分为2组:一组行甲状腺全切除术+患侧中央区淋巴结清扫。一组行患侧甲状腺腺叶+峡部切除术+中央区淋巴结清扫术,各50例,统计两组标本的癌灶数目、中央区淋巴结清扫总数、淋巴结转移数目、甲状旁腺误切数目。监测术后24,48,72h血钙、血磷、甲状旁腺激素的水平,记录低钙血症及喉返神经、喉上神经的损伤情况。结果:甲状腺全切除组多发癌灶10例,多于对照组的5例(P<0.05)。中央区淋巴结清扫总数甲状腺全切除组256枚、平均(5.12±1.42)枚/例;对照组240枚,平均(4.8±1.39)枚/例,差异无统计学意义(P>0.05)。转移淋巴结数甲状腺全切除组为128枚(50%),对照组为124枚(51.7%),差异无统计学意义(P>0.05)。中央区淋巴结转移例数甲状腺全切除组23例(46%),对照组21例(42%),差异无统计学意义(P>0.05)。2组患者甲状旁腺误切情况、一过性及永久性低钙血症、喉返神经损伤、喉上神经损伤发生率比较差异无统计学意义(P>0.05)。术后两组患者随访24-56个月,甲状腺全切除组无复发及转移。对照组4例术后1-2年对侧出现癌灶,补充行对侧腺叶切除加中央区淋巴结清扫。2例术后1.5和3年分别出现患侧颈侧区淋巴结转移,补充行功能性颈淋巴结清扫术。2组复发及转移率比较差异有统计学意义(P<0.05)。2组均无死亡发生。结论:在cN0甲状腺乳头状癌手术治疗中,甲状腺全切除和患侧中央区淋巴结清扫术能避免术后癌灶残留,与患侧甲状腺腺叶+峡部切除术+患侧中央区淋巴结清扫术相比,其术后复发和转移风险降低,且不增加术后并发症的发生。

Objective： To compare the effect of different operations in the treatment on thyroid papillary carcinoma with negative clinical lymphnode （cN0）. Methods： One hundred cases with cN0 thyroid papillary microcarcinoma were selected, who had undergone treatment in our hospital from January 2010 to September 2012, and randomly divided into two groups, 50 cases of each. One group underwent total thyroidectomy plus ipsilateral central lymphnode dissection. Another underwent ipsilateral thyroid gland and sthmectomy plus central lymph node dissection. The number of cancer, the number of central lymphnode dissected, the number of lymph node metastasis and the number of parathyroid inadvertently cut were counted. The level of serum calcium, phosphorus and parathyroid hormone were monitored at the end of 24, 48, and 72 hours after operation. Hypocalcemia,injury of the recurrent laryngeal nerve and superior laryngeal nerve were recorded. Results： Ten cases of multiple tumor in group of total thyroidectomy were more than those of the control group with only 5 eases （P〈0.05）. No difference between the two groups were found in the numbers of central lymphnode dissected, lymphnode metastasis, and parathyroid inadvertently cut. Two groups were followed up 24 to 56 months after operation. There was no recurrence and metastasis in the total thyroideetomy group. In the control group, eontralateral cancer appeared in 4 cases 1-2 years after operation and underwent a supplementary contralateral lobeetomy plus central lymphnode dissection. Ipsilateral lateral neck lymphnode metastasis were found in 2 cases in 1.5 and 3 years respectively after operation and underwent a supplementary functional neck dissection. The differences in recurrence and metastasis showed statistical significance （P% 0.05）. No death occurred in both two groups. Conclusion= Compared with the ipsilateral thyroid gland and isthmectomy plus central lymph node dissection, in the surgical treatment on cN0 thyroid papillary cancer, total thyroidectomy plus ipsilateral central lymphnode dissection can avoid the residual carcinoma after operation, and reduce the postoperative recurrence and metastasis risk, which does not increase the occurrence of postoperative complications.