摘要
目的总结甲状腺乳头状癌术后复发的部位及特征。方法回顾性分析2017年1月至2024年3月期间因甲状腺乳头状癌术后复发就诊于郑州大学附属肿瘤医院并施行再次手术的96例患者的临床资料。结果96例患者中甲状腺复发3例,淋巴结复发89例,甲状腺及淋巴结复发4例;单次复发69例,多次复发27例。接受残叶切除+侧区清扫10例,中央区清扫8例,侧区清扫33例,中央区+侧区清扫45例;术后病理学检查示淋巴结转移93例(中央区转移16例,侧区转移44例,中央区+侧区转移33例),未转移3例;淋巴结包膜外侵犯58例。与多次复发患者比较,单次复发患者的年龄更小(t=–3.385,P=0.001),术中淋巴结肉眼包膜外侵犯发生率较低(χ^(2)=6.970,P=0.008),转移淋巴结数量较多(t=4.034,P=0.001),Ⅱ、Ⅲ、Ⅳ区淋巴结转移率较高(χ^(2)=8.142,P=0.004;χ^(2)=6.357,P=0.012;χ^(2)=12.547,P<0.001)。结论甲状腺乳头状癌术后复发以淋巴结复发为主,高龄及肉眼可见的淋巴结包膜外侵犯可能增加甲状腺乳头状癌术后多次复发风险。中央区淋巴结转移可能是导致患者多次复发和手术的原因。
Objective Explore the impact of a digital-intelligence-based quality control platform for thyroid cancer on the effectiveness of clinical diagnosis and treatment quality management.Methods The digital-intelligencebased quality control platform for thyroid cancer at Zhejiang Provincial People’s Hospital was launched at the end of July 2022.In its initial phase,six quality control indicators related to the standardized diagnosis and treatment of thyroid cancer were deployed.This study analyzed the changes in these six quality control indicators between January 2022 and November 2023, comparing data before and after the platform’s implementation. Results Compared with the period fromJanuary to July 2022 (prior to the platform’s launch), the rates of preoperative cytopathological examination (t=–8.490,P<0.001) and postoperative pTNM staging for thyroid cancer patients (t=–3.027,P=0.013) increased from July to November2023 (one year post-launch). However, the proportion of minimally invasive surgeries among thyroid cancer patients(t=4.085,P=0.002) decreased. The linear regression model results indicated that, following the platform’s launch, therewas a gradual increase over time in both the preoperative cytopathological examination rate for thyroid cancer (P=0.001)and the postoperative pTNM staging rate (P=0.049). Conclusion Preliminary results of this study suggest that thethyroid cancer digital-intelligence-based quality control platform developed by our team can effectively enhance thestandardized quality control of clinical diagnosis and treatment for thyroid cancer.
作者
白杨
马炜柯
周斌
张璐瑶
李艳青
黑虎
XU Jiajie;CHEN Yiwei;CHEN Keyu;HUANG Xingyu;TAN Zhuo;ZHENG Chuanming;XIN Ying;TAN Mingming;GUO Haiwei;GUO Yawen;YANG Wenjing;GE Minghua(Department of Head and Neck Surgery,Otolaryngology&Head and Neck Center,Cancer Center,Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital of Hangzhou Medical College),Hangzhou 310014,P.R.China;Thyroid Cancer Expert Committee of National Cancer Quality Control Center,National Cancer Center,Beijing 100000,P.R.China;Zhejiang Provincial Clinical Research Center for Malignant Tumor,Hangzhou 310014,P.R.China;Zhejiang Key Laboratory of Precision Medicine Research on Head&Neck Cancer,Hangzhou 310014,P.R.China;Second Clinical Medical College,Zhejiang University of Chinese Medicine,Hangzhou 310014,P.R.China;Department of Quality Management,Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital of Hangzhou Medical College),Hangzhou 310014,P.R.China;National Cancer Center,National Cancer Clinical Medical Research Center,Quality Control Office of Cancer Diagnosis and Treatment,Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100000,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2024年第11期1336-1340,共5页
Chinese Journal of Bases and Clinics In General Surgery
基金
河南省科技攻关项目(项目编号:232102310059、242102310408)。
