两种不同术式治疗Ⅰ或Ⅱ期分化型甲状腺癌的疗效比较

Comparison of two surgical procedures for stage Ⅰ or Ⅱ differentiated thyroid carcinoma

目的比较全甲状腺切除术(TT)+患侧中央区淋巴结清扫术(LND)和患侧甲状腺腺叶+峡部切除+患侧中央区LND对Ⅰ或Ⅱ期分化型甲状腺癌(DTC)疗效。方法将104例术前诊断为单侧Ⅰ或Ⅱ期DTC患者分为A组(54例)和B组(50例)。A组行TT+患侧中央区LND,B组行患侧甲状腺腺叶+峡部切除+患侧中央区LND。分析两组癌灶检出率、手术情况和不良事件。结果与B组比较,A组双侧癌灶和多发癌灶检出率较高(P<0.05),手术时间延长(P<0.01)出血量增多(P<0.01),暂时性低血钙发生率增高(P<0.05),但术后复发率、转移率较低(P<0.05)。结论 TT+患侧中央区LND对Ⅰ或Ⅱ期DTC疗效更好。

Objective To compare the clinical efficacy of total thyroidectomy（TT） plus unilateral lymph node dissection（LND） versus unilateral lobectomy plus isthmectomy and unilateral LND for stage Ⅰ or Ⅱ differentiated thyroid carcinoma（DTC）.Methods A total of 104 patients with stage Ⅰ or Ⅱ DTC were divided into Groups A（n=54） and B（n=50）,and underwent TT plus unilateral LND and unilateral lobectomy plus isthmectomy and unilateral LND,respectively.Dection rate of cancerous foci,operation indexes and adverse events were compared between two groups.Results Compared with Group B,dection rate of multiple cancerous foci in unilateral or bilateral lobes,operating time,bleeding volume,incidence of temporary hypocalcemia were increased（P〈0.01-0.05）,but postoperative recurrence and metastasis were decreased（P〈0.05）in Group A.Conclusion TT plus unilateral LND is more suitable for stage Ⅰ or Ⅱ DTC.