1 173例甲状腺乳头状癌外科治疗远期疗效观察

A Long Term Observation of 1173 Cases with Thyroid Papillary Carcinoma after Surgery

目的:探讨甲状腺乳头状癌的外科治疗效果和影响生存因素。方法:选取1954～1991年间手术治疗,并随访10年以上甲状腺乳头状癌1173例。按手术方式分为腺叶切除术组和腺叶切除合并颈淋巴结清除术组,两组进行分析。结果:腺叶切除术组中腺内型癌的10和20年无瘤生存率分别为94.6%、94.0%,腺外型癌分别为40.8%、35.0%。腺叶切除合并颈淋巴结清除术组中腺内型癌施行选择性和治疗性颈清术的10年无瘤生存率分别为97.0%、90.8%,腺外型癌分别为87.9%、53.2%;20年无瘤生存率腺内及腺外型癌分别为93.9%、84.3%,77.4%、31.9%。结论:甲状腺乳头状癌的外科治疗均需施行患侧腺叶切除术,当同侧颈淋巴结出现转移时,需合并功能性或传统性颈淋巴结清除术;当触不到颈部肿大淋巴结时,根据原发癌侵犯程度决定是否合并颈清术;包膜内癌的颈淋巴结转移率为20.5%,不宜施行颈清术;癌侵出包膜的腺内型癌及腺外型癌,其淋巴结转移率分别为69.1%、73.4%,均宜施行选择性功能性颈清术。

Objective:To evaluate the surgical therapeutic effect and survival factors of pap illary thyroid cancer.Methods:1173cases with pap illary carcinoma of the thyroid gland were treated surgically at the Tianjin Cancer Hospital during1954to1991.All of these patients were received follow-up for over10years.The patients had divid ed into two groups in terms of the operative procedures used.Results:In the lobecyomy group,the10-and20-year disease-free survival rate was94.6%and94.0%for the intraglandular le sions,40.8%and35.0%for the ex-traglandular lesions.In the combined radical resection group,the10-year disease-free survival rate with elective and therapeutic dissection for the in traglandu lar and extraglandular lesions was97.0%and90.8%,87.9%and53.2%,respectively;the20-year dis ease-free survival was93.9%and84.3%,77.4%and31.9%,respectively.Conclu sions:Lobecy omy of the involved thyroid lobe is proved to be adequate.When metastasis had developed in the lateral cervical region,a func-tional or conventional neck dissection should be performed.With no palpable enlarged nodes,the management varied with the degree of extension of the primary le sions.A neck dissection is un-necessary in cases with the lesion is intracapsular,as the frequency of nodal metastasis was20.5%.A functional neck dissection appears to be ap propriate in the le sions of extracapsular as the nodal metastasis occurred in the intraglandular and extraglandular lesions were69.1%and73.4%,respectively.