Graves’病合并甲状腺微乳头状癌的回顾性病例对照分析  

Graves＇ disease associated with papillary thyroid microcarcinoma：a retrospective case-control analysis

作　　者：薛帅[1] 王培松[1] 张丽[1] 王墨[1] 陈光[1] 

机构地区：[1]吉林大学白求恩第一医院甲状腺外科,长春130021

出　　处：《中华内分泌外科杂志》2015年第1期13-16,共4页Chinese Journal of Endocrine Surgery

摘　　要：目的 结合国内外发表的文献，就Graves’病合并甲状腺微乳头状癌的临床特点及诊疗方法，做一回顾性分析。方法 总结分析了2008年6月1日至2013年6月1日吉林大学第一医院甲状腺外科诊治的32例Graves’病合并甲状腺微乳头状癌的患者资料，同时通过随机数表法，随机抽取同时期32例甲状腺功能（简称“甲功”）正常的单纯甲状腺微乳头状癌患者作为对照。结果 实验组32例年龄24～71岁。其中男3例，女29例，男女比例为1：9．7。实验组中央区淋巴结转移阳性15例，阴性17例，对照组阳性7例，阴性25例。实验组阳性淋巴结个数平均值为3±2．88个，而对照组为1．71±1．25个。实验组阳性淋巴结转移的比率（阳性淋巴结个数／中央区清扫总淋巴结个数，且中央区清扫总淋巴结个数≥3）为（50．34±27．09）％，对照组为（33．50±30．79）％。以上中央区淋巴结转移的3项指标，经统计学分析，实验组均高于对照组（P值分别为0．035，0．039和0．018）。结论 Graves’病合并甲状腺微乳头状癌比单独甲状腺微乳头状癌患者更易发生中央区淋巴结转移，转移的阳性淋巴结更多，转移比率更高，为防止术后Graves’病和甲状腺癌局部淋巴结的复发，甲状腺全切加中央区淋巴结清扫为理想术式。Objective To investigate the clinical characteristics, diagnosis and treatment for Graves＇ disease associated with papillary thyroid microearcinoma（PTMC） by retrospectively analyzing domestic and foreign literatures. Methods 32 patients of Graves＇ disease associated with PTMC treated at the Department of Thyroid Surgery, the First Bethune Hospital of Jilin University from Jun. 2008 to Jun. 2013 were collected. 32 cases of PTMC with normal thyroid function were randomly selected by a random number table method from the same period as control. Results The experimental group had 32 patients aging from 24 to 71 years old, among whom 3 were males, and 29 were females with the male to female ratio was 1：9. 7. 15 cases in the experimental group had positive central lymph node metastasis and the other 17 cases were negative, while in the control group 7 cases were positive and 25 cases were negative. The mean number of positive lymph nodes was 3 ± 2. 88 in the experimental group and 1.71 ± 1.25 in the control group. The ratio of positive lymph node metastasis（ the number of positive lymph nodes/the total number of lymph nodes, and the total number of central lymph nodes was ≥3 ） was （50. 34 ±27.09）% in the experimental group and（33.5±30. 79）% in the control group. For the above 3 values of central lymph node metastasis, the experimental group were all higher than those of the control group（P = 0. 035,0. 039,0. 018 respectively）. Conclusions Compared with patients of PTMC, patients of Graves＇ disease associated with PTMC are more likely to have central lymph node metastasis, more number of positive lymph node and higher metastasis ratio. In order to prevent the postoperative recurrence of Graves＇ disease and thyroid carcinoma local lymph node, total thyroidectomy plus central lymph node dissection should be the ideal operation method.

关 键 词：Graves’病 甲状腺微乳头状癌 淋巴结转移 颈部清扫 

分 类 号：R581.1[医药卫生—内分泌]