甲状腺乳头状癌的临床病理特征及预后分析

Clinicopathological Features and Prognosis of Papillary Thyroid Carcinoma

目的研究甲状腺乳头状癌的临床病理特征及预后,供临床借鉴。方法以2003年1月—2018年12月该院接诊的甲状腺乳头状癌患者76例为研究对象,并对其病例资料进行综合分析,充分了解甲状腺乳头状癌的病理特征,同时经过随访了解该组患者的预后情况。结果 76例患者中,有浸透亦或者是浸润包膜者有40例(52.63%),有纤维性间质反应者有24例(31.58%),血管中存在癌栓者有9例(11.84%)。核空,为毛玻璃样改变,部分伴有假包涵体与核沟者有71例(93.42%)。存在砂砾体者有21例(27.63%),滤泡型乳头状癌者有6例(7.89%)。随访1~15年,健康存活者有64例(84.21%),其年龄为(32.18±2.67)岁;复发者有7例(9.21%),其年龄为(41.68±3.29)岁;死亡者有5例(6.58%)。其年龄为(44.07±3.82)岁。男性10例中,健康存活4例,复发4例,死亡2例;女性66例中,健康存活60例,复发3例,死亡3例。该组76例患者在入院后都接受手术治疗,同时在术后应用甲状腺素片,并辅以化疗亦或者是放疗。经分析比较可见,单纯肿瘤切除治疗者的健康存活率为76.92%,腺叶扩大切除治疗者的健康存活率为85.00%;腺叶切除联合双侧颈淋巴结清扫治疗者的健康存活率为100.00%,腺叶切除联合单侧颈淋巴结清扫治疗者的健康存活率为82.35%。其中,单纯肿瘤切除治疗者的健康存活率最低,腺叶切除联合双侧颈淋巴结清扫治疗者的健康存活率最高。结论对甲状腺乳头状癌者而言,其预后通常比较好,尤其是隐形乳头状癌者,其预后更好。通过单纯肿瘤切除治疗,并不能获得较为理想的预后,而淋巴结清扫和腺叶扩大切除治疗者的预后则比较好。

Objective To study the clinicopathological features and prognosis of papillary thyroid carcinoma for clinical reference. Methods A total of 76 patients with thyroid papillary carcinoma who were admitted to our hospital from January 2003 to December 2018 were enrolled in the study. The medical records were analyzed comprehensively to fully understand the pathological features of papillary thyroid carcinoma. Follow-up was conducted to understand the prognosis of this group of patients. Results Of the 76 patients, 40 cases (52.63%) were infiltrated or infiltrated, 24 cases (31.58%) had fibrous interstitial reaction, and 9 cases had tumor thrombus in the blood vessels (11.84%). Nuclear space was changed for ground glass, and 71 cases (93.42%) were accompanied by pseudo inclusion bodies and nuclear sulcus. There were 21 cases (27.63%) with gluten and 6 cases (7.89%) with follicular papillary carcinoma. During the followup period of 1-15 years, 64 patients (8.421%) were healthy survivors, and their age was (32.18±2.67) years old;7 patients (9.21%) had recurrence, and their age was (41.68±3.29) years old;5 cases (6.58%) of death. Its age was (44.07 ± 3.82) years old. Among the 10 males, 4 survived healthy, 4 relapsed, and 2 died. Among 66 females, 60 survived healthily, 3 relapsed, and 3 died. In this group, 76 patients were treated with surgery after admission. At the same time, thyroxine tablets were applied after surgery, supplemented by chemotherapy or radiotherapy. According to the analysis, the healthy survival rate of patients with simple tumor resection was 76.92%, the survival rate of patients with enlarged gland resection was 85.00%;the survival rate of patients with gland resection combined with bilateral cervical lymph node dissection was 100.00%. The healthy survival rate of patients treated with lobectomy and unilateral cervical lymph node dissection was 82.35%. Among them, the simple survival rate of patients with simple tumor resection was the lowest, and those with treatment of lobectomy and bilateral cervical lymph node dissection had the highest health survival rate. Conclusion For patients with papillary thyroid carcinoma, the prognosis is usually better, especially in patients with invisible papillary carcinoma, the prognosis is better. The treatment of simple tumor resection does not lead to a better prognosis, and the prognosis of patients with lymph node dissection and enlarged glandular resection is better.