预防性颈侧区淋巴结清扫对CN0期甲状腺乳头状癌患者甲状腺功能、并发症及预后的影响

Effects of Prophylactic Cervical Lateral Lymph Node Dissection on Thyroid Function,Complications and Prognoses of Patients with CN0 Stage Papillary Thyroid Carcinoma

目的分析预防性颈侧区淋巴结清扫对CN0期甲状腺乳头状癌(PTC)患者的临床价值。方法回顾性分析2015年12月—2019年12月收治的784例CN0期PTC患者的临床资料。根据手术方法分为A组343例和B组441例,A组行甲状腺全切加中央区淋巴结清扫术,B组在A组基础上给予患侧预防性颈侧区淋巴结清扫术。分析2组颈部淋巴结转移情况,比较手术前后甲状旁腺功能、血钙水平、并发症及预后。结果784例CN0期PTC患者中发生颈部淋巴结转移338例(43.11%)。与术前比较,2组术后7 d甲状旁腺激素、血钙水平显著下降,且B组下降更为显著(P<0.05,P<0.01)。2组术后并发症总发生率比较差异无统计学意义(P>0.05)。术后随访1年,与A组比较,B组局部复发率和再次手术率均明显降低(P<0.05)。结论预防性颈侧区淋巴结清扫可降低CN0期PTC局部复发率,减少因淋巴结转移导致的再次手术。

Objective To analyze the clinical value of prophylactic cervical lateral lymph node dissection in patients with CN0 stage papillary thyroid carcinoma(PTC).Methods Clinical data of 784 patients with PTC at CN0 stage admitted between December 2015 and December 2019 was retrospectively analyzed.The patients were divided into group A(n=343)and group B(n=441)according to different surgical methods.Group A was treated with total thyroidectomy+central lymph node dissection,while group B was added with prophylactic cervical lateral lymph node dissection for affected side on the basis of treatment for group A.In two groups,conditions of neck lymph node metastasis were analyzed,and parathyroid functions,levels of blood calcium,complications and prognoses were compared before and after operations.Results Among 784 PTC patients at CN0 stage,338(43.11%)had cervical lymph node metastasis.Compared with those before operation,levels of parathyroid hormone and blood calcium were significantly decreased after operation for 7 d in two groups,and the decrease in group B was more significant(P<0.05,P<0.01).No significant difference was found in the total incidence rate of postoperative complications between two groups(P>0.05).The patients were followed up for 1 year after operation,and the local recurrence rate and reoperation rate in group B were significantly lower than those in group A(P<0.05).Conclusion The prophylactic cervical lateral lymph node dissection may reduce the local recurrence rate and reoperation rate due to lymph node metastasis in treatment of patients with PTC at CN0 stage.