甲状腺全切联合颈Ⅵ区淋巴结清扫对cN0期甲状腺乳头状癌患者血PTH、Ca2+、CD+3、CD+4、CD+8的影响

Effects of total thyroidectomy;lymph node removing in neckⅥarea on the levels of PTH,blood Ca,CD+3,CD+4,CD+8 in patients with thyroid papillary carcinoma

目的研究甲状腺全切与颈Ⅵ区淋巴结清扫联用对颈淋巴结阴性(cN0)期甲状腺乳头状癌患者血甲状旁腺激素(PTH)、血Ca2+、CD+3、CD+4、CD+8水平的影响。方法回顾性分析2014年2月至2015年2月院接受甲状腺全切治疗的cN0期甲状腺乳头状癌患者48例为对照组,另取2015年6月至2016年6月接受甲状腺全切联合颈Ⅵ区淋巴结清扫治疗的cN0期甲状腺乳头状癌患者48例为研究组。对比2组术后不同时间点血Ca2+、PTH水平,治疗前后CD+3、CD+4、CD+8水平,术后并发症及预后情况。结果术后5个月研究组血Ca2+、PTH水平相比对照组较高(均P<0.05)。治疗后研究组CD+3、CD+4水平相比对照组较高,而CD+8水平相比对照组较低(均P<0.05)。2组甲状旁腺损伤、饮水呛咳、声嘶、呼吸困难发生率差异无统计学意义(P>0.05)。2组复发、死亡发生率差异无统计学意义(P>0.05);研究组淋巴结转移发生率相比对照组降低(P<0.05)。结论甲状腺全切与颈Ⅵ区淋巴结清扫联用可显著改善cN0期甲状腺乳头状癌患者PTH、血Ca2+水平,同时不会对免疫功能造成严重影响,安全性较好,值得推广应用。

Objective To investigate the Effects of total thyroidectomy;lymph node removing in neckⅥarea on the levels of PTH,blood Ca2+,CD+3,CD+4,CD+8 in patients with thyroid papillary carcinoma.Methods The clinical data about 48 patients with stage cN0 papillary thyroid cancer who were treated by total thyroidectomy in our hospital from February 2014 to February 2015 were retrospectively analyzed,the 48 patients were enrolled as control group,at the same time,the other 48 patients with stage cN0 papillary thyroid cancer who were treated by total thyroidectomy combined with lymph node removing in neckⅥarea in our hospital from June 2015 to June 2016 were enrolled as research group.The levels of blood Ca and blood PTH at different time points after surgery,and the levels of CD+3,CD+4 and CD+8 before and after treatment,and the incidence rate of postoperative complications and prognosis of patients were observed and compared between the two groups.Results At 5 months after surgery,the levels of blood Ca2+and PTH in research group were significantly higher than those in control group(P<0.05).After treatment,the levels of CD+3 and CD+4 in research group were significantly higher than those in control group,however,the CD+8 levels were significantly lower than those in control group(P<0.05).There were no significant differences in the incidence rates of parathyroid gland injury,water coughing,hoarseness and dyspnea as well as the incidence rates of relapse and death between the two groups(P>0.05).Moreover the incidence rate of lymph node metastasis in research group was significantly lower than that in control group(P<0.05).Conclusion The total thyroidectomy combined with lymph node removing in neckⅥarea can significantly improve tgthe levels of PTH and blood Ca of patients with stage cN0 thyroid papillary carcinoma,at the same time,which will not cause serious effects on the immune function of patients,with good security.Therefor,it is worthy of clinical application and promotion.