手术治疗分化型甲状腺癌合并淋巴细胞性甲状腺炎的临床疗效分析

Surgical treatment of differentiated thyroid cancer with lymphocytic thyroiditis

目的 探讨手术治疗分化型甲状腺癌(DTC)合并淋巴细胞性甲状腺炎(LT)的临床疗效。方法回顾性分析我院2013年12月至2015年12月经病理证实为DTC合并LT行手术治疗的147例患者的临床资料,统计患者的手术操作时间、术中平均出血量、术后住院时间、临床疗效、术前和术后1d时的血清甲状旁腺激素(PTH)水平及血钙水平、术后并发症。结果147例患者平均手术操作时间(126.23±30.65)min,术中出血量(22.18±10.19)mL,术后住院时间(3.30±1.06)d。经治疗显效84例、有效55例、无效8例,总有效率为94.56%(139/147)。术后1d时血清PTH水平及血钙水平明显低于术前(P<0.05)。术后出现并发症21例(14.29%),手足抽搐3例(2.04%),声音嘶哑5例(3.40%),呼吸困难4例(2.72%),窒息1例(0.68%),甲状旁腺损伤5例(3.40%),甲状腺危象3例(2.04%)。结论分化型甲状腺癌合并淋巴细胞性甲状腺炎采用甲状腺切除术联合区域性颈部淋巴结廓清术进行手术治疗,并配合甲状腺素片进行后续内分泌治疗,效果较好,可行性强。

Objective To analyze the efficacy of surgical treatment on differentiated thyroid cancer(DTC)complicated with lymphocytic thyroiditis(LT).Methods The clinical data of 147 patients with pathologically confirmed DTC and LT in our hospital from December 2013 to December 2015 were retrospectively analyzed.The operative time,average intraoperative blood loss,postoperative hospital stay,total effective rate,serum parathyroid hormone(PTH)levels and serum calcium levels at 1 day pre-operation and post-operation,as well as the postoperative complications were analyzed.Results The operation time,average intraoperative blood loss and hospital stay of 147 patients were(126.23±30.65)min,(22.18±10.19)mL,(3.30±1.06)d,respectively.The total effective rate was 94.56%(139/147),including 84 effective cases,55 valid cases and 8 invalid cases.The serum PHT and calcium levels at 1 day post-operation were lower than those 1 day pre-operation(P<0.05).Postoperative complications occurred in 21 cases(14.29%),including 3 cases of hand-foot convulsions(2.04%),5 cases of hoarseness(3.40%),4 cases of dyspnea(2.72%),1 case of asphyxia(0.68%),5 cases of parathyroid injury(3.40%)and 3 cases of thyroid crisis(2.04%).Conclusion The application of the thyroidectomy plus regional neck lymph node dissection combined with the levothyroxine is an effective surgical treatment for patients with differentiated thyroid cancer with lymphocytic thyroiditis.