单侧多灶性甲状腺癌临床病理特点和手术方式比较

CLINICOPATHOLOGICAL FEATURES AND SURGICAL PROCEDURES OF UNILATERAL MULTIFOCAL THYROID CARCINOMA

目的研究单侧多灶性甲状腺乳头状癌(MPTC)的临床病理特点,并了解单侧MPTC不同手术方式治疗的效果。方法比较单侧MPTC(127例)和双侧MPTC(80例)病人的临床特点;将单侧MPTC病人分为全甲状腺切除术组(70例)和甲状腺部分切除术组(57例),比较两组术中及术后情况,分析术后复发或转移的危险因素。结果单侧MPTC的临床病理因素与双侧MPTC相比,差异无统计学意义(P>0.05)。单侧MPTC不同方式手术组的手术时间差异有显著性(t=9.063,P<0.05)。多因素分析示,甲状腺包膜侵犯(OR=26.392,95%CI=2.373~344.254,P<0.05)和手术方式(OR=0.041,95%CI=0.003~0.436,P<0.05)是单侧MPTC术后复发的独立危险因素。结论单侧MPTC的临床病理因素与双侧MPTC相比无差异;甲状腺全切除术可以有效降低单侧MPTC术后复发或转移率,尤其对癌灶侵出包膜病人。

Objective To investigate the clinicopathological features of unilateral multifocal papillary thyroid carcinoma （MPTC） and the therapeutic effects of different surgical procedures on unilateral MPTC. Methods Clinical features were com- pared between patients with unilateral MPTC （127 patients） and those with bilateral MPTC （80 patients）. The patients with uni- lateral MPTC were divided into total thyroidectomy group （70 patients） and partial thyroidectomy group （57 patients）, and the two groups were compared in terms of intraoperative and postoperative conditions and risk factors for postoperative recurrence or metastasis. Results There were no significant differences in clinicopathological features between the patients with unilateral MPTC and those with bilateral MPTC （P〉0.05）. There was a significant difference in the time of operation between the total thy- roidectomy group and the partial thyroidectomy group （t=9.063,P〈O.05）. The multivariate analysis showed that thyroid extra- capsular extension （odds ratio （OR）=26.392,95% confidence interval （C1）=2.373--344.254,P〈0.05） and surgical procedure （ OR = O. 041,95 % CI = 0.003 -- 0.436, P〈 0.05 ） were independent risk factors for the postoperative recurrence of unilateral MPTC. Conclusion There are no significant differences in clinicopathological features between the patients with unilateral MPTC and those with bilateral MPTC. Total thyroidectomy can effectively reduce the postoperative recurrence or metastasis rate of unilateral MPTC, especially in patients with thyroid extracapsular extension.