全甲状腺切除加中央区淋巴结清扫术治疗甲状腺乳头状癌92例的临床观察

Efficacy of total thyroidectomy and central lymph node dissection in treating thyroid papillary carcinoma: a clinical review of 92 cases

目的探讨全甲状腺切除加中央区淋巴结清扫术治疗甲状腺乳头状癌的临床效果。方法 173例甲状腺乳头状癌患者中81例行全甲状腺切除术(对照组),92例行全甲状腺切除术加中央区淋巴结清扫术(观察组),术后随访18个月,观察两组患者的乳头状癌复发及颈侧淋巴结转移、肺转移情况,并对比两组术后并发症情况。结果观察组乳头状癌复发及转移的总发生率(6.52%)显著低于对照组(22.22%),差异有统计学意义(χ~2=8.887,P=0.003);患者术后主要的并发症为低钙血症、声音嘶哑、永久性甲状旁腺功能低下、术腔积液及伤口感染等,两组间并发症的发生率差异无统计学意义(P>0.05)。结论全甲状腺切除术加中央区淋巴结清扫术治疗甲状腺乳头状癌,可显著降低术后复发率和转移率,且不增加术后并发症发生率。

Objective To evaluate the clinical efficacy of total thyroidectomy combined with central lymph node dissection for the treatment of thyroid papillary carcinoma. Methods Firstly, 173 patients of thyroid papillary carcinoma were chosen as the subjects of study. 81 were subjected to total thyroidectomy and chosen as the control group while the other 92 were subjected to total thyroidectomy plus central lymph node dissection and chosen as the experimental group. All patients were followed up for 18 months. Incidence of recurrence of papillary carcinoma, cervical lymph node metastasis, lung metastasis, and postoperative complications in the two groups were observed and compared. Results The rate of recurrence and metastasis of the experimental group (6.52%) was significantly lower than that of the control group (22.22%). The difference was statistically significant (χ 2 =8.887, P =0.003). The main postoperative complications were hypocalcemia, hoarse voice, permanent hypoparathyroidism, intraoperative fluid accumulation and wound infection. No significant difference was found between the two groups in the rate of incidence of complications ( P >0.05). Conclusions Total thyroidectomy combined with central lymph node dissection for the treatment of thyroid papillary carcinoma can significantly reduce the recurrence rate and metastasis rate without increasing the rate of incidence of postoperative complications.