术前高频彩超指导分化型甲状腺癌淋巴结清扫的应用

Application of High Frequency Color Doppler Ultrasound Before Operation Guiding for Cervical Lymph Node Dissection in Differentiated Thyroid Carcinoma

目的对比分析分化型甲状腺癌患者手术切除甲状腺组织后是否行淋巴结清扫及清扫范围的临床预后。方法连续选择2012年3月~2014年11月入我院确诊为分化型甲状腺癌患者共80例,该研究取得我院伦理委员会通过及患者、家属的知情同意权后,根据入院先后顺序将其分为对照组(n=36)和观察组(n=44),两组患者均行甲状腺全切或次全切除术,对照组不行或根据术者经验清扫最为可疑淋巴结,观察组术前行高频彩超检查,术中尽可能清扫最大范围淋巴结,对比两组患者临床效果及预后差异性。结果随访约1年,观察组肿瘤复发率显著低于对照组,生存率明显高于对照组,差异均有统计学意义(P<0.05);两组患者的手术并发症发生率,比较差异无统计学意义(P>0.05);术前高频彩超判断淋巴结转移与术中确诊比较,敏感性为97.4%,特异性为33.3%,阳性预测值为90.2%和阴性预测值为66.7%。结论结合术前高频彩超判断分化型甲状腺癌患者手术切除甲状腺组织后行淋巴结清扫及清扫范围有较高的准确性、效果好、复发率低,有较大的参考价值。

Objective To comparatively analyze the range and clinical prognosis of cervical lymph node dissection in resection surgical of differentiated thyroid carcinoma if color Doppler ultrasound was used or not before operation. Methods Total 80 patients with differentiated thyroid carcinoma who were diagnosed successively from March 2012 to March 2014, were selected and divided into control group(n=36) and observation group (n=44) according to the order of admission. The study had been approved by ethics committee of our hospital, as well as respecting patient and relative’s right of informed consent.All patients were performed total or subtotal thyroidectomy, and control group underwent non or simple cervical lymph node dissection based on the operators’ experience, while observation group underwent cervical lymph node dissection at the maximum range in view of examination of high frequency color Doppler ultrasound before operation. Results With followupone year, the recurrence rate of tumor in observation group was significantly lower than that of control group, and the survival rate was significantly higher, the differences were statistically significant (P<0.05). However, the difference had no statistical significance in incidence of operative complications in the two groups (P>0.05).For comparing the preoperative diagnosis of lymph node metastasis by high frequency color Doppler ultrasound and intraoperative confirmed detection, the sensitivity was 97.4%, specificity was 33.3%, positive predictive value was 90.2% and negative predictive value was 66.7%. Conclusion Preoperative diagnosis of differentiated thyroid carcinoma by high frequency color Doppler ultrasound could be combined to cervical lymph node dissection at the dissection range after surgery of resecting thyroid tissue so as to increase accuracy, decrease recurrence and make a good effect, which had a great reference value.