甲状腺乳头状癌不同治疗方式的疗效比较

Efficacy of different treatments for patients with papillary thyroid cancer:A comparative study

目的探讨颈部淋巴结阴性(c N0)甲状腺乳头状癌不同治疗方式的临床效果。方法收集解放军总医院2013年1月-2014年6月180例甲状腺全切的c N0甲状腺乳头状癌患者的临床资料并进行回顾性分析,患者分别行甲状腺全切+中央区淋巴结清扫(A组,60例),甲状腺全切+术后^(131)I治疗(B组,60例),甲状腺全切+中央区淋巴结清扫+术后^(131)I治疗(C组,60例),比较3组不同治疗方案对于c N0甲状腺乳头状癌患者的疗效。3组间男女比例、平均年龄、肿瘤性质等一般资料差异无统计学意义(P>0.05)。结果患者侧颈部淋巴结转移率及原因不明的血清甲状腺球蛋白升高率C组<A组<B组(P<0.05);术后3组患者喉返神经及喉上神经损伤、甲状旁腺功能低下等并发症的发生率差异无统计学意义(P>0.05)。结论 cN0甲状腺乳头状癌患者行中央区淋巴结清扫+术后^(131)I治疗可有效降低肿瘤的远期复发转移率,且不增加术后并发症发生风险。

Objective To investigate prognosis of patients with c N0 papillary thyroid cancer treated by different surgical procedures and postoperative therapy.Methods Retrospective analysis of 180 patients with c N0 papillary thyroid cancer from January 2013 to June 2014 in the department of general surgery of Chinese PLA General Hospital was performed,then patients were divided into total thyroidectomy with central lymph node dissection group（A,n=60） total thyroidectomy with postoperative （131） I therapy group（B,n=60） and total thyroidectomy with central lymph node dissection and postoperative （131） I therapy group（C,n=60） to investigate the prognosis treated by different methods.Those male/female ratio,average age,tumor characteristics between three groups showed no statistical significance（P〈0.05）.Results The cervical lymph node metastasis rate and the elevated serum thyroglobulin with no evidence rate were group Cgroup Agroup B（P〉0.05）.The differences in incidences of postoperative complications including recurrent laryngeal nerve injury,superior laryngeal nerve injury and hypoparathyroidism between three groups showed no statistical significance（P〉0.05）.Conclusion Total thyroidectomy with central lymph node dissection ＋ postoperative （131） I therapy can efficiently reduce the long-term recurrence rate and metastasis rate in patients with c N0 papillary thyroid cancer,which does not increase the complications.