70例甲状腺乳头状癌手术治疗的临床分析

Clinical analysis of surgical treatment of 70 cases of papil-lary thyroid carcinoma

目的 ：探讨甲状腺乳头状癌（PTC）临床特点和手术治疗效果及其预后。方法：回顾性分析2005-2012年手术治疗的70例PTC患者临床资料,并对其预后进行随访观察。结果：54例（77.1%）患者行甲状腺切除术及颈部淋巴结清扫,其余患者仅行甲状腺腺叶切除术。术后病理提示,31例（44.3%）患者的肿瘤长径〈1 cm,29例（41.4%）患者伴有颈部淋巴结转移,27例（38.6%）患者伴有中央区淋巴结转移。25例术前检查淋巴结转移阴性在术中进行预防性中央区淋巴结清扫的患者中,4例（16%）病理显示淋巴结转移。4例患者出现术后并发症。4例患者出现局部复发,2例患者出现远处转移,在术后1年内死亡。至末次随访,患者总生存率为97.1%。结论：手术是PTC安全有效的治疗手段,术中预防性中央区淋巴结清扫是有必要的。对于分期较晚的PTC患者,术后进行放射性碘治疗可降低复发风险。

Objective： To evaluate the surgical methods and prognosis of patients with papillary thyroid carcinoma（PTC）. Methods： We selected 70 Papillary thyroid carcinoma patients undergone radical thyroidectomy with or without selective lymph node dissection in Department Of breast and thyroid surgery at Shandong provincial hospital between 2005 and 2012, analyzed the clinicopathologic data and prognosis retrospectively. Results： We did Radical Thyroidectomy with selectedlymph node dissection in 77.1% cases and reminders undergone Radical Thyroidectomy. 44.3% tumor was 1cm in longest diameter. 41.4% cases has lymph node metastasis and 38.6% has central lymph node metastasis. 16% cases found lymph node metastasis in the patients of clinical negative lymph node metastasis. Radio ablation by using radio Iodine（I131）needed in 5 patients.5.7% cases operative or postoperative complications observed. The rate of local recurrence is 5.7%, Distant metastasis of served in 2 cases were died after 1 year. Untill the last follow, the overall survival rate was 97.1%. Conclusion： Surgical management is a safe and increase survival with possibility of cure in papillary thyroid carcinoma and prophylactic central lymph node dissection is necessary. For the patient of late stage, radiotherapy after surgery will receive a promising outcome.