甲状腺乳头状癌区域淋巴结清扫与^(131)I治疗的对比分析  

Comparative analysis of regional lymph node dissection and ^(131)I therapy for papillary thyroid carcinoma

作　　者：高庆坤[1] 孔娜[1] 任洺[1] 赵志铭[1] 吴燕[1] 宋春芳[1] 周毅[1] 

机构地区：[1]哈尔滨医科大学第一附属医院甲乳外科中心实验室,黑龙江哈尔滨150001

出　　处：《中国普通外科杂志》2013年第5期585-589,共5页China Journal of General Surgery

摘　　要：目的:比较甲状腺乳头状癌中央组淋巴结清扫与131I辅助治疗的临床效果。方法:选择5年半内收治的390例甲状腺乳头状癌cN0患者的临床资料行回顾性分析,患者分别行甲状腺全切除+中央组淋巴结清扫(A组),甲状腺全切除+术后131I治疗(B组)和单纯甲状腺全切除术(C组)。结果:中央组淋巴结清扫组(A组)与非清扫组(B+C组)各种术后并发症(喉返神经损伤、喉上神经损伤、甲状旁腺功能低下)发生率差异无统计学意义(均P>0.05);B组131I治疗后放射病发生率为51.5%。3组术后5年复发率与转移率比较,A组中央区复发率分别为0,明显低于B组(7.7%)和C组(13.8%)(均P<0.05);A,B,C组颈侧区转移率及无影像学证据血清甲状腺球蛋白升高率依次增高(1.5%,6.2%,9.2%;3.1%,7.7%,15.4%),其中A组与C组间差异有统计学意义(均P<0.05)。B组平均住院日最长,住院费用最高,与A,C组比较,差异均有统计学意义(均P<0.05)。结论:甲状腺乳头状癌患者常规行中央组淋巴清扫有助于降低复发率,且无增加手术并发症风险;131I治疗不能完全代替淋巴结清扫术,且患者并发症、住院日和费用增加。Objective： To compare the clinical e cacies between central compartment dissection and131I ablation for papillary thyroid cancer（PTC） following total thyroidectomy.Methods： Three hundred and ninety patients with cN0 PTC treated within five and a half years in our hospital were selected and their clinical data were retrospectively analyzed.Patients underwent either totalthyroidectomy plus central compartment dissection（group A） or total thyroidectomy plus 131 I ablation（group B） or total thyroidectomy only（group C）.Results： The differences in incidences of postoperative complications that included recurrent laryngeal nerve injury,superior laryngeal nerve injury and hypoparathyroidism between group of patients with central compartment dissection（group A） and group of patients without central compartment dissection（group B and C） showed no statistical significance（all P0.05）,and radiation injury associated with 131 I therapy in group B was 51.5%.Comparisons in 5-year recurrence and metastasis among the three groups showed that the central compartment recurrence in group A was 0,which was significantly lower than that in group B（7.7%） or group C（13.8%）（both P0.05）.The incidences of lateral neck metastases and elevated serum thyroglobulin with no radiographic evidence presented an increase in ascending order in group A,B and C（1.5%,6.2% and 9.2%;3.1%,7.7% and 15.4%,respectively）,and the differences between group A and C had statistical significance（both P0.05）.The average length of hospital stay was longest with the highest hospitalization costs for group B,and the differences had statistical significance versus group A or group C（all P0.05）.Conclusion： Total thyroidectomy with central lymph node dissection for papillary thyroid cancer reduces the recurrence rate without an increased risk of complications.131 I treatment cannot completely replace lymph node dissection,and may also increase the associated complications,length of hospital stay and expenses of t

关 键 词：甲状腺肿瘤 外科学 甲状腺切除术 颈淋巴结清扫术 碘放射性同位素 

分 类 号：R736.1[医药卫生—肿瘤]