全甲状腺切除+预防性中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌103例临床分析

Total Thyroidectomy plus Prophylactic Central Lymph Node Dissection in Treatment of Multifocal Papillary Thyroid Carcinoma:A Clinical Analysis of 103 Cases

目的总结多灶性甲状腺乳头状癌的临床病理学特征,评估全甲状腺切除＋预防性中央区淋巴结清扫术在治疗多灶性甲状腺乳头状癌中的临床意义及安全性。方法回顾性分析2011年6月至2015年2月期间于湖北医药学院附属东风医院接受全甲状腺切除＋预防性中央区淋巴结清扫术的103例多灶性甲状腺乳头状癌患者的病例资料。结果 103例多灶性甲状腺乳头状癌患者均行全甲状腺切除＋预防性中央区淋巴结清扫术。单侧多发病灶55例（53.40%）,双侧多发病灶48例（46.60%）。中央区淋巴结转移31例（30.10%）,其中单侧多发病灶者中央区淋巴结转移16例（29.10%）,均为患侧中央区淋巴结转移;双侧多发病灶者中央区淋巴结转移15例（31.25%）,其中双侧转移7例,单侧转移8例。术后13例（12.62%）出现暂时性的低钙血症;1例（0.97%）发生永久性的甲状旁腺功能损伤;18例（17.48%）出现喉返神经短暂性麻痹,没有发生永久性喉返神经损伤的病例;3例（2.91%）术后出现短暂性饮水呛咳。术后所有患者均获访,随访时间为5个月-4年,中位数为28个月。随访期间3例（2.91%）出现侧颈区淋巴结转移。结论全甲状腺切除＋预防性中央区淋巴结清扫术对治疗多灶性甲状腺乳头状癌有重要意义。

Objective To analyze the clinical and pathological features of multifocal papillary thyroid carcinoma, and to assess the value and safety of total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma. Methods Clinical data of 103 patients with multifocal papillary thyroid carcinoma, who underwent total thyroidectomy plus prophylactic central lymph node dissection in Affliated Dongfeng Hospital from June 2011 to February 2015 were collected retrospectively. Preoperative ultrasound showed that all patients didn’t suffered from cervical lymph node metastasis. Results Among 103 patients who underwent total thyroidectomy plus central lymph node dissection, the unilateral multiple lesions were found in 55 patients（53.40%）, and the bilateral multiple lesions were found in 48 patients（46.60%）. A total of 31 patients（30.10%） were confirmed to have central lymph node metastasis after operation, central lymph node metastasis only located in the same side of multifocal papillary thyroid carcinoma in 16 patients（29.10%）, but of 15 patients（31.25%） with 2-side of multifocal papillary thyroid carcinoma, 7 patients suffered from 2-side central lymph node metastasis and 8 patients suffered from 1-side central lymph node metastasis. Thirty patients（12.62%） suffered from transient postoperative hypocalcemia after operation, and returned to normal for longest of 2 weeks; 1 patient（0.97%） suffered from parathyroid permanent damage; 18 patients（17.48%） suffered from transient recurrent laryngeal nerve palsy, no one suffered from permanent recurrent laryngeal nerve injury; 3 patients（2.91%） suffered from postoperative transient drinking cough. All of 103 patients were followed up for 5 months to 4 years, and the postoperative follow-up rate was 100%. During the follow-up period, 3 patients（2.91%） suffered from cervical lymph node metastasis in side region of neck. Conclusion Total thyroidectomy plus prophylactic central lymph node dissection plays an important role in the treatment of multifocal papillary thyroid carcinoma.