PTC术中提示1~2枚中央区淋巴结转移选择不同手术方式的获益分析

Benefits of different surgical methods for 1-2 central lymph node metastases during operation of papillary thyroid carcinoma

目的:探讨适用于术中1~2枚中央区淋巴结转移的甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的手术方式。方法:收集2013年1月至2018年12月于重庆医科大学附属第一医院乳腺甲状腺外科行初次手术的术中1~2枚中央区淋巴结转移的PTC患者290例,并分析其临床病理学特征。结果:甲状腺腺叶切除术(hemithyroidectomy,HT)组的手术并发症发生率显著低于甲状腺全切除术(total thyroidectomy,TT)组(P<0.001)。手术方式不影响结构持续性/复发性疾病的发生(HR=2.848,95%CI=0.321~25.294,P=0.348)。淋巴结总转移数>5枚的独立危险因素为肿瘤直径>14.5 mm(OR=5.838,95%CI=2.295~14.850,P<0.001)、肿瘤位于上份(OR=2.765,95%CI=1.154~6.624,P=0.023)、Ⅲ区淋巴结有转移(OR=17.310,95%CI=7.053~42.481,P>0.001)。结论:目前结果支持术中提示1~2枚中央区淋巴结转移的PTC患者的首选手术方式为甲状腺腺叶切除术。若肿瘤位于上份且直径>14.5 mm,建议行预防性的同侧Ⅲ区颈淋巴结清扫。

Objective:To explore the surgical method for papillary thyroid carcinoma(PTC)with 1-2 central lymph node metastases during surgery.Methods:A total of 290 patients with PTC and 1-2 central lymph node metastases during the primary surgery in the De-partment of Breast and Thyroid Surgery of The First Affiliated Hospital of Chongqing Medical University were collected from January 2013 to December 2018,and their clinicopathological features were analyzed.Results:The incidence of surgical complications in the hemithyroidectomy(HT)group was significantly lower than that in the total thyroidectomy group(P<0.001).The surgical method did not affect the occurrence of structurally persistent/recurrent diseases(HR=2.848,95%CI=0.321-25.294,P=0.348).The independent risk factors for total number of lymph node metastases>5 were tumor diameter>14.5 mm(OR=5.838,95%CI=2.295-14.850,P<0.001),tumor location in the upper part(OR=2.765,95%CI=1.154-6.624,P=0.023),and metastasis to zoneⅢlymph nodes(OR=17.310,95%CI=7.053-42.481,P<0.001).Conclusion:The current results support that the preferred surgical method for patients with PTC and 1-2 central lymph node metastases during surgery is HT.If the tumor is located in the upper part and has a diameter of more than 14.5 mm,it is recommended to undergo prophylactic ipsilateral neck lymph node dissection in zone Ⅲ.