全腔镜甲状腺切除术治疗分化型甲状腺癌的效果及复发危险因素分析

Clinical Efficacy of Total Laparoscopic Thyroidectomy in Treatment of Patients with Differentiated Thyroid Cancer and Its Risk Factors for Recurrence

目的分析全腔镜甲状腺切除术治疗分化型甲状腺癌(DTC)的临床疗效及复发独立危险因素。方法回顾性分析2015年3月—2017年3月本院收治的112例DTC患者的临床资料。根据手术方式不同分为传统组55例和全腔镜组57例。传统组采用传统开放甲状腺切除术,全腔镜组采用全腔镜甲状腺切除术。术后3年完成随访105例,根据复发情况分为复发组32例及无复发组73例。比较传统组和全腔镜组临床疗效、甲状腺功能变化情况[包括血清三碘甲状腺原氨酸(T_(3))、甲状腺素(T_(4))、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)]及并发症发生情况。分析影响DTC患者复发的危险因素。结果全腔镜组总有效率高于传统组(P<0.05)。与术前比较,2组术后T_(3)、T_(4)、FT_(3)、FT_(4)降低,TSH升高,且全腔镜组较传统组变化更显著,差异有统计学意义(P<0.01)。全腔镜组并发症发生率显著低于对照组(P<0.05)。有淋巴结转移、临床分期为Ⅲ~Ⅳ期、传统开放式甲状腺切除术、术后未进行放化疗是DTC患者甲状腺切除术后复发的独立危险因素(P<0.01)。结论全腔镜甲状腺切除术可促进DTC患者甲状腺功能恢复,疗效佳、安全性高;对合并危险因素的DTC患者进行合理干预,可减低术后复发率,改善预后。

Objective To analyze clinical efficacy of total laparoscopic thyroidectomy in treatment of patients with differentiated thyroid cancer(DTC)and its independent risk factors for recurrence.Methods Clinical data of 112 DTC patients admitted during March 2015 and March 2017 was retrospectively analyzed,and the patients were divided into traditional group(n=55)and total laparoscopy group(n=57)according to different surgical methods.Traditional group underwent traditional open thyroidectomy,while total laparoscopy group underwent total laparoscopic thyroidectomy.A total of 105 patients were followed up for 3 years after operation,and they were divided into recurrence group(n=32)and non-recurrence group(n=73)according to recurrence conditions.Clinical efficacy changes of thyroid functions[including serum triiodothyronine(T_(3)),thyroxine(T_(4)),free triiodothyronine(FT_(3)),free thyroxine(FT_(4))and thyroid-stimulating hormone(TSH)]and incidence rate of complications were compared in two groups.Risk factors affecting recurrence of DTC patients were analyzed.Results The total effective rate in the total laparoscopy group was significantly higher than that in traditional group(P<0.05).After surgery,levels of T_(3),T_(4),FT_(3) and FT_(4) were significantly lower,while TSH levels were significantly higher than those before surgery in two groups,and the changes of the above levels were more significant in the total laparoscopy group than those in the traditional group(P<0.01).The incidence rate of complications in the total laparoscopy group was significantly lower than that in the traditional group(P<0.05).The presence of lymph node metastasis,clinical stageⅢ-Ⅳ,traditional open thyroidectomy,no postoperative radiotherapy or chemotherapy were independent risk factors that affected the prognoses of DTC patients after thyroidectomy(P<0.01).Conclusion Total laparoscopic thyroidectomy may promote recovery of thyroid function of patients with DTC with good curative efficacy and safety.Reasonable intervention for patients with risk factors may reduce postoperative recurrence rate and improve the prognosis.