早期分化型甲状腺癌的手术治疗

Surgical management of early welldifferentiated thyroid carcinoma

摘要:

目的 探讨早期分化型甲状腺癌的手术方式及行中央区颈廓清术的必要性。方法回顾性分析诊治的46例早期分化型甲状腺癌患者，根据肿瘤在甲状腺中所处的位置及病理类型确定手术方式，其中行甲状腺侧叶次全切除术2例，腺叶切除术6例，腺叶+峡部全切除术8例，甲状腺次全切除术28例，甲状腺全切除术2例；同期行VI区颈廓清术44例，并采用统计学方法分析患者性别、年龄、体重指数、肿瘤分期与颈部淋巴结转移之间的规律。结果46例患者术后随访3~5年，均未发现复发及淋巴结转移。性别、体重与颈部淋巴结转移无关（P均>0.05），年龄、肿瘤分期、肿瘤病理类型分别与颈部VI区淋巴结转移相关（χ2=10.125，P<0.05；χ2=6.597，P<0.05；χ2=13.455，P<0.01）。结论早期分化型甲状腺癌的淋巴结转移与患者年龄、肿瘤分期及其病理类型相关，根据肿瘤的大小、在甲状腺中的位置及病理类型明确手术方式。

Abstract:

Abstract:ObjectiveTo study the surgical management of early welldifferentiated thyroid carcinoma and the necessity of the Level VI lymph node dissection.MethodsClinical data of 46 patients suffering from early welldifferentiated thyroid carcinoma was retrospectively studied. All the patients underwent thyroid operation and 44 cases underwent the Level VI lymph node dissection. The surgical method relied largely on the location and pathology of the tumor. Subtotal lobectomy was performed in 2 cases, lobectomy in 6, total excision of thyroid isthmus and leave in 8, subtotal thyroidectomy in 28 and total thyroidectomy in 2. At the same time, Level VI lymph node dissection was performed in 44 cases. The relationship between cervical lymphatic metastasis and patients’ gender, age, body mass index, tumor stages were statistically analyzed.ResultsNeither relapse nor lymphatic metastasis occurred in all cases after followed up for 3 to 5 years postoperatively. There were no significant relationships between patients’ gender, body mass index and neck lymph node metastasis (both P>0.05), while the lymphatic metastasis was significantly associated with patients’ age, pathology and clinical stage of the tumor (χ2=10.125, P<0.05; χ2=6.597, P<0.05; χ2=13.455, P<0.01).ConclusionsThe lymphatic metastasis is closely associated with patients’ age, pathology and clinical stage of early welldifferentiated thyroid carcinoma. The surgical method relies mainly on the size, location and pathology of the tumor.