选择性颈淋巴结清除术治疗乳头状甲状腺癌的临床效果

Clinical effect of selective cervical lymph node dissection in the treatment of papillary thyroid carcinoma

目的探讨选择性颈淋巴结清除术治疗乳头状甲状腺癌的临床效果。方法选取2018年3月12日~2019年3月18日大连市中心医院收治的120例乳头状甲状腺癌患者作为研究对象,按照单双号随机化分组分为观察组(60例)与对照组(60例)。对照组采用常规甲状腺切除术治疗,观察组采用选择性颈淋巴结清除术治疗。比较两组的淋巴结清扫数、住院时间、术中出血量、手术时间、视觉模拟量表(VAS)评分、术后7 d阳性率、并发症发生率、12个月复发率、结节体积缩小率、结节体积及促甲状腺激素(TSH)、血清游离三碘甲状腺原氨酸(FT_(3))、血清游离甲状腺素(FT_(4))水平。结果观察组的并发症发生率、术后7 d阳性率、12个月复发率、VAS评分低于对照组,差异有统计学意义(P<0.05);观察组的结节体积小于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);观察组的淋巴结清扫数多于对照组,差异有统计学意义(P<0.05);观察组的手术时间、住院时间短于对照组,差异有统计学意义(P<0.05);观察组的FT_(3)、FT_(4)、TSH水平及结节体积缩小率高于对照组,差异有统计学意义(P<0.05)。结论对乳头状甲状腺癌患者实施选择性颈淋巴结清除术的治疗效果显著,能够改善甲状腺功能,降低术后并发症发生率,缩小结节体积。

Objective To explore the clinical effect of selective cervical lymph node dissection in the treatment of papillary thyroid cancer.Methods A total of 120 patients with papillary thyroid cancer admitted to Dalian Central Hospital from March 12,2018 to March 18,2019 were selected as the research subjects.They were divided into the observation group(n=60)and the control group(n=60)according to odd and even numbers randomization.In the control group,conventional thyroidectomy was used,and in the observation group,selective cervical lymph node dissection was adopted.The number of lymph node dissections,hospital stay,intraoperative blood loss,operation time,visual analog scale(VAS)score,positive rate at 7 days after surgery,incidence of complications,12 months of recurrence rate,nodule volume reduction rate,nodule volume and the level of thyroid stimulating hormone(TSH),serum free triiodothyronine(FT_(3)),and serum free thyroxine(FT_(4))were compared between the two groups.Results The incidence of complications,positive rate of 7 days after operation,12-month recurrence rate,VAS score of the observation group were lower than those of the control group,with statistical significance(P<0.05).The nodule volume of the observation group was less than that of the control group,the intraoperative blood loss of the observation group was less than that of the control group,and the differences were statistically significant(P<0.05).The number of lymph node dissections of the observation group was more than that of the control group,and the difference was statistically significant(P<0.05).The operation time and hospital stay of the observation group were shorter than those of the control group,and the differences were statistically significant(P<0.05).The levels of FT_(3),FT_(4),TSH and the reduction rate of nodule volume of the observation group were higher than those of the control group,with statistical significance(P<0.05).Conclusion Selective cervical lymphadenectomy for patients with papillary thyroid cancer has a remarkable effect,which can improve thyroid function,and reduce postoperative incidence of complications and the current nodule volume.