预防性中央区淋巴结清扫在甲状腺乳头状癌手术治疗中的应用价值

Prophylactic Central Lymph Node Dissection Analysis of Application Value in the Operation in the Treatment of Thyroid Papillary Carcinoma

目的探讨预防性中央区淋巴结清扫在甲状腺乳头状癌患者手术治疗中的应用效果。方法选取240例甲状腺乳头状癌患者,所有患者颈侧区淋巴结均为阴性,采用随机数字表法将这些患者均分为研究组与对照组。两组患者均施行甲状腺癌切除术,研究组加行中央区淋巴结清扫,对照组患者不清扫淋巴结。观察两组患者术后并发症发生情况、术后局部转移情况、再次手术率。结果术后研究组患者12例出现暂时性低钙血症,8例出现喉返神经短暂性麻痹、4例出现短暂性饮水呛咳,术后并发症总发生率20%,对照组患者14例出现暂时性低钙血症,5例出现喉返神经短暂性麻痹,6例出现短暂性饮水呛咳,术后并发症总发生率20. 83%,两组相比不具有统计学意义(P>0. 05);研究组患者术后随访5年内,无患者淋巴结发生转移,再次手术率为零,对照组患者术后随访5年内有9例患者发生同侧淋巴结转移,在本院再次施行手术,发生率为7. 5%,两组相比具有统计学差异(P <0. 05)。结论对甲状腺乳头状癌患者施行手术时,即使淋巴结无浸润转移,但施行中央区淋巴结清扫,能预防甲状腺癌远期转移与复发,同时安全性高。

Objective To investigate the preventive effect of central lymph node dissection in surgical patients with papillary thyroid carcinoma.Methods 240 cases of patients with thyroid papillary carcinoma were selected in our hospital.All patients were negative for lymph nodes.The patients were divided into the study group and the control group by random digital table method.Two groups of patients were treated with thyroid cancer resection,study group underwent lymph node dissection,the control group of patients without lymph node dissection.The postoperative complications of the two groups were observed,and the postoperative local metastasis and reoperation rate were observed.Results After the operation of 12 patients had temporary hypocalcemia,8 cases of recurrent laryngeal nerve paralysis,4 cases of transient transient bucking,incidence rate of postoperative complications was 20%.The control group of 14 patients with temporary hypocalcemia,5 cases of transient recurrent laryngeal nerve paralysis,6 cases had transient bucking,postoperative complication rate of 20.83%,compared to the two groups was not statistically significant(P>0.05).Study group of patients with postoperative follow-up of 5 years,patients with no lymph node metastasis,reoperation rate is zero.The control group of patients after 5 years of follow-up in the ipsilateral lymph node metastasis in9 patients in our hospital underwent surgery again,the incidence rate was 7.5%,there was significant difference between two groups(P<0.05).Conclusion For patients with papillary thyroid carcinoma surgery,even without lymph node metastasis,but underwent lymph node dissection,can prevent metastasis and recurrence of thyroid cancer and long-term,high safety.