不同手术方式治疗分化型甲状腺癌的疗效及影响因素分析

Curative effect and influencing factors of different surgical methods in patients with differentiated thyroid cancer

目的探讨甲状腺叶及峡部切除术、甲状腺全切术治疗分化型甲状腺癌的临床疗效,并分析影响疗效的因素。方法回顾性分析2014年10月至2017年10月间于肇庆市广宁县人民医院外科二区手术治疗的135例分化型甲状腺癌患者的临床资料,其中69例(次全切组)采用甲状腺叶及峡部切除术,66例(全切组)采用甲状腺全切术,两组患者均行双侧颈部淋巴结清扫。比较两组患者的临床治疗效果和并发症发生情况,Logistic回归分析影响分化型甲状腺癌无进展生存和总生存的因素。结果次全切组和全切组患者的治疗有效率(91.30%vs 92.42%)、术后住院时间[(6.05±2.01) d vs (5.98±2.15) d]比较差异均无统计学意义(P>0.05);次全切组与全切组患者术中喉返神经损伤发生率(2.90%vs 15.15%)、术后发音困难发生率(0 vs 9.09%)、无进展生存率(59.42%vs 80.30%)比较,次全切组明显低于全切组,而复发转移率(13.04%vs 3.03%)比较,次全切组明显高于全切组,差异均有统计学意义(P<0.05);单因素分析结果显示,分化型甲状腺癌无进展生存与病理类型、是否行甲状腺全切术、TNM分期、肿瘤大小、颈部淋巴结转移有关(P<0.05);Logistic回归分析结果显示,肿瘤直径≥3 cm、滤泡型、淋巴结转移转移、TNM分期是影响分化型甲状腺癌预后的危险因素(P<0.05)。结论甲状腺全切术可降低术后复发和转移,提高无进展生存率,但并发症风险较大;肿瘤直径、病理类型、淋巴结转移转移、TNM分期是影响分化型甲状腺癌预后的危险因素。

Objective To investigate the clinical efficacy of lobectomy and isthmus thyroidectomy and total thyroidectomy in the treatment of differentiated thyroid cancer, and to analyze the influencing factors. Methods The clinical data of 135 patients with differentiated thyroid cancer who underwent surgery in Guangning People’s Hospital from Oct. 2014 to Oct. 2017 were retrospectively analyzed. Among the patients, 69 patients(subtotal thyroidectomy group) underwent lobectomy and isthmus resection, and 66 patients(total thyroidectomy group) underwent total thyroidectomy. Both groups underwent bilateral neck lymph node dissection. The clinical efficacy and complications of the two groups were observed, and the factors influencing progression-free survival and total survival of differentiated thyroid cancer were analyzed by logistic analysis. Results There was no difference in the effective rate of treatment and hospitalization time between the two groups: 91.30% vs 92.42%,(6.05±2.01) d vs(5.98±2.15) d, all P>0.05. The incidence of recurrent laryngeal nerve injury, dysphonia, progression-free survival, and recurrence and metastasis of subtotal thyroidectomy group were respectively 2.90%, 0, 59.42%, 13.04%, versus 15.15%, 9.09%, 80.30%, 3.03% of the total thyroidectomy group(all P<0.05). Univariate analysis showed that progression-free survival of differentiated thyroid cancer was related to pathological type, total thyroidectomy, tumor-node-metastasis(TNM) stage, tumor size and cervical lymph node metastasis(all P<0.05).Logistic regression analysis showed that tumor diameter(>3 cm), follicular type, lymph node metastasis and TNM stage were risk factors affecting the prognosis of differentiated thyroid cancer(all P<0.05). Conclusion Total thyroidectomy can reduce the recurrence and metastasis and improve the progression-free survival rate, but the risk of complications is high.Tumor diameter, pathological type, lymph node metastasis and TNM stage are risk factors affecting the prognosis of differentiated thyroid cancer.