分化型甲状腺癌再次手术疗效及影响预后的多因素分析

The curative effect of differentiated thyroid cancer re-operation and multivariate analysis on factors influencing prognosis

目的探讨分化型甲状腺癌再次手术的疗效,并分析预后的影响因素。方法分化型甲状腺癌再次手术患者183例,分析其术后并发症、淋巴结转移和预后,分析预后的影响因素。结果患者术后并发症主要为呼吸困难(2.73%)、暂时性喉返神经损伤(1.64%)、低钙血症(2.73%)等。患者淋巴结转移率为76.50%(140/183),5年存活率为87.98%(161/183)。年龄<45岁、病灶结节<2 cm、无癌灶残留或复发、TNM分期Ⅰ~Ⅱ期的患者5年存活率高于年龄≥45岁、病灶结节≥2 cm、有癌灶残留或复发、TNM分期Ⅲ~Ⅳ期的患者(P<0.05)。年龄、癌灶残留或复发、TNM分期是再次手术患者预后的独立影响因素。结论分化型甲状腺癌再次手术患者5年存活率较高,年龄、有无癌灶残留或复发、TNM分期是影响患者预后的主要因素。

Objective To explore the curative effect of differentiated thyroid cancer(DTC)re-operation,and to analyze influencing factors of prognosis.Methods One hundred and eighty-three patients who underwent DTC re-operation in our hospitals were enrolled.The postoperative complications,lymph node metastasis and prognosis were recorded and factors influencing prognosis were analyzed.Results Postoperative complications of patients were mainly on dyspnea(2.73%),temporary recurrent laryngeal nerve injury(1.64%)and hypocalcemia(2.73%).The lymph node metastasis rate and 5-year survival rate were 76.50%(140/183)and 87.98%(161/183),respectively.The 5-year survival rate in patients with age less than 45 years old,lesion nodule size less than 2 cm,absence of cancer lesions residual or recurrence,and TNM staging at stage I^II was higher than that with age older than 45 years old,lesion nodule size larger than 2 cm,cancer lesions residual or recurrence,TNM staging at stage III^IV(P<0.05).Age,cancer lesions residual or recurrence and TNM staging were independent influencing factors for prognosis of patients undergoing re-operation.Conclusion The 5-year survival rate is higher in patients undergoing DTC re-operation.Age,cancer lesions residual or recurrence and TNM staging are main factors influencing prognosis of the patients.