多灶性甲状腺癌的危险因素评估和治疗策略

Risk factors and treatment of multifocal thyroid cancer

目的探讨多灶性甲状腺癌的危险因素及治疗策略。方法分析116例多灶性甲状腺癌和309例单灶性甲状腺癌的临床特征。采用t检验和χ2检验统计分析,评估多灶性甲状腺癌的危险因素,提出治疗策略。结果多灶组甲状腺癌侵犯包膜率大于单灶组;多灶组淋巴结转移率高、病期晚(P<0.05)。多灶性甲状腺癌中,肿瘤直径>1 cm、病灶数>2个、侵犯包膜、中央区有可疑淋巴结容易出现中央区淋巴结转移(P<0.05)。结论多灶性甲状腺癌比单灶性甲状腺癌病期晚,被膜容易受侵,更容易发生中央区淋巴结转移。多灶性甲状腺癌行全甲状腺切除加中央区淋巴结清扫是安全、必要的。

Objective To explore the risk factors of muhifocal thyroid cancer and its treatment strategies. Methods Clinical features of 116 patients with multifoeal thyroid carcinoma and 309 patients with unifocal thyroid carcinoma were analyzed. T test andχ2 test were used to evaluate the risk factors of multifocal thyroid carcinoma. The possible treatment strategies were proposed. Results Both the capsule invasion rate and the lymph node metastasis rate in the muhifocal group were greater than those in the unifocal group （ P 〈 0.05 ）. The stage of disease in the muhifoeal group was later than that in the unifoeal group （P 〈 0.05）. In muhifocal papillary thyroid carcinoma with tumor diameter greater than 1 era, the number of lesions greater than 2 and capsule invasion and central suspicious lymph node, it was prone to central lymph node metastasis （ P 〈 0. 05 ）. Conclusions The disease stage of multifocal thyroid cancer was later than that of unifoealcaneer, with easy membrane invasion, more prone to lymph node metastasis. Total thyroidectomy plus lymph node dissection would be safe and necessary in patients with multifocal thyroid carcinoma.