不同手术方式对分化型甲状腺癌治疗的临床效果及其影响因素分析

Clinical Effect of Different Surgical Methods for Differentiated Thyroid Carcinoma and Its Influencing Factors

目的不同手术方式对分化型甲状腺癌临床应用的分析,并探讨影响治疗效果的因素。方法将240例分化型甲状腺癌患者按照手术方式分为4组,每组患者60例。A组为甲状腺全切术,B组甲状腺全切加单双侧颈淋巴结清扫,C组患侧腺叶及峡部切除,D组在C组基础上行对侧大部切除术。对比分析4组手术治疗的临床效果,并对所有患者随访并分析影响临床效果的因素。结果 4组不同手术方式对分化型甲状腺癌治疗的总有效率差异不具统计学意义(P>0.05)。甲状腺切除的患者无病生存率较未行甲状腺切除的患者高,但总生存率差异无统计学意义。甲状腺癌预后与患者性别、年龄,甲状腺癌的病理类型、肿瘤分期有关(P均<0.05)。结论不同手术方式对分化型甲状腺癌治疗各有利弊,治疗方案的选择应遵循个体化原则,肿瘤的病理类型和分期对患者预后影响显著。

Objective To analyze the different surgical methods for differentiated thyroid carcinoma, and to explore the factors affecting the therapeutic effects. Methods 240 patients with differentiated thyroid cancer, according to the mode of opera- tion, were divided into 4 groups ,60 cases in each group. Group A underwent thyroidectomy, group B underwent thyroid lobectomy plus single bilateral cervical lymph node dissection, group C underwent side lobe and isthmus resection, group D received uplink contralateral subtotal resection based on group C. Comparative analysis of the clinical effect of 4 groups were conducted, and all patients were followed up and factors affecting the clinical results were analyzed. Results There had no significant difference in the total effective rate among the 4 groups （ P 〉 0.05 ）. The disease-free survival rate of patients with thyroid resection was higher than those without thyroid resection, but the overall survival had no significant difference. The prognosis of thyroid carcinoma is re- lated to sex and age. Prognosis of thyroid carcinoma was related with gender, age, pathological type and tumor staging of thyroid carcinoma patients. Conclusion Different surgical methods have advantages and disadvantages in the treatment of differentiated thyroid cancer, and the choice of treatment plan should be individualized. The pathological type and stage of tumor have significant effect on the prognosis of patients.