分化型甲状腺癌手术方式选择及复发因素探讨  

Influencial factors of differentiated thyroid carcinoma recurrence

作　　者：马建仓[1] 金迎迎[1] 赵军[1] 张大华[1] 纪宗正[1] 

机构地区：[1]西安交通大学医学院第二附属医院普外科,陕西西安710004

出　　处：《现代肿瘤医学》2007年第2期189-192,共4页Journal of Modern Oncology

摘　　要：目的探讨分化型甲状腺癌外科手术的方式及影响其复发的因素。方法回顾性分析我院行手术治疗的149例分化型甲状腺癌,研究其治疗方法并进行随访,根据不同病理类型、临床分期及手术方式分组,计算复发率及生存率,观察影响预后的因素。结果行患侧腺叶切除加峡部切除29例,患侧腺叶切除加峡部切除加颈清扫40例,患侧腺叶、峡部加对侧腺叶次全切除16例,患侧腺叶、峡部加对侧腺叶次全切除加颈部淋巴结清扫46例,甲状腺全切加颈清扫13例,姑息性切除5例。1年、3年、5年和10年生存率分别为100%、95.9%、92.6%和87.2%。获得随访的98例中,除6例姑息性切除病例外,其余92例中癌肿复发16例(17.4%),其中颈淋巴结复发12例,甲状腺复发4例,合并远处转移2例。统计学分析显示,癌肿复发与性别、手术方式无相关性(P>0.05),但与年龄、临床分期、辅助治疗密切相关(P<0.05)。结论分化型甲状腺癌手术应根据病理类型、临床分期行患侧叶、峡部切除加对侧叶次全切,或全甲状腺切除术。有颈淋巴结转移者应行颈清扫术。其预后与年龄、临床分期、术后是否放疗、是否长期服用甲状腺素密切相关。Objective： To discuss the methods of surgical operation for differentiated thyroid carcinoma and the post- operational recurrence- related factors. Methods： To analyze retrospectively 149 cases of differentiated thyroid carcinoma after surgical operation, and observe the prognosis - related factors. Results： Six teen cases received resection of pathological lobe and isthmus of thyroid gland, 40 cases resection of pathological lobe and isthmus and radical dissection of neck lymph nodes, 16 cases resection of pathological lobe of isthmus and subtotal resection of contralateral lobe ,46 cases resection of pathological lobe , isthmus, and subtotal resection of contralateral lobe , and radical dissection of neck lymph nodes, 13 cases total thyroidectomy and radical dissection of neck lymph nodes ,5 cases palliative surgery. The 1 - year,3 - year,5 - year, 10 - year survival rates were 100% ,95.9% ,92.6% ,87.2%, respectively,16 cases of 98 following- up cases recurred except 6 cases of palliative surgery, 12 cases of neck lymph nodes recurred ,4 cases of thyroid gland recurred ,2 cases of concurrent metastatic status recurred. The recurrences of DTC had no relation with sex, modus operation, （ P 〉 0.05 ） but had closed relation with age, pathologic types, clinical stage and adjunctive therapy （ P 〈 0.05 ）. Conclusion： The operational methods of differentiated thyroid carci -noma should select resection of pathological lobe and isthmus and subtotal resection of contralateral lobe, or total thy- roidectomy according to the pathological type, clinical stage and should perform radical dissection of neck lymph nodes if there was neck lymph node metastasis. The prognosis of differentiated thyroid carcinoma is closely related with age, pathological type, clinical stage radiotherapy or take thyroxine long -termly after operation.

关 键 词：甲状腺肿瘤 手术 复发 影响因素 

分 类 号：R736.1[医药卫生—肿瘤]