腔镜辅助甲状腺微小乳头状癌手术中两种切除方式的对比观察  

A comparative study on two kinds of operation procedures for laparoscopic assissted resection of papillary thyroid microcarcinoma

作　　者：华科俊[1] 胡贤杰[1] 张星[1] 陈文忠[1] 

机构地区：[1]宁波大学附属鄞州人民医院普外科,浙江宁波315040

出　　处：《临床和实验医学杂志》2016年第18期1827-1830,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的对比分析腔镜辅助甲状腺微小乳头状癌(PTMC)手术中连续整块切除和分块切除的优劣性,为今后PTMC腔镜下手术完善和疗效提高提供参考。方法 2010年3月至2011年5月行腔镜辅助下甲状腺癌根治术的微小乳头状癌患者62例。其中30例患者行分块切除归为对照组;32例行连续整块切除归为观察组。对比两组患者手术用时、术中出血量、中央区淋巴结清扫数量、术后喉返神经损伤等并发症发生情况;随访5年记录两组患者病死率及肿瘤复发转移率。结果观察组手术用时(87.21±9.25 min)明显长于对照组(72.64±9.10 min);观察组中央区淋巴结清扫数量(7.82±1.32枚)明显多于对照组(5.94±1.30枚);观察组5年肿瘤转移发生率(6.25%)明显低于对照组(16.67%),差异均有显著性(P<0.05)。两组患者术中出血量、5年病死率等无显著差异(P>0.05)。结论连续整块切除应用在腔镜甲状腺微小乳头状癌中会延长手术时间,但不会增加术中出血量,更利于清除癌灶,符合无瘤原则,减少远期转移,安全性好。Objective To compare the advantages and disadvantages of laparoscopic - assisted papillary thyroid microcarcinom （ PTMC） resection in continuous en bloc resection and divided block resection, and to provide reference for improvement of the efficacy of laparascopic oper-ation for PTMC. Methods A total of 62 patients with small papillary thyroid cancer underwent laparoscopic assissted radical thyroidectomy in this hospital during March 2012 to May 2011 were allocated in this study. Among them, 30 patients underwent divided block resection were listed in control group, and 32 cases classified as en bloc resection were listed in observation group. The operating time, amount of blood loss during operation ,the number of central lymph nodes dissected, the incidence of complications and postoperative recurrent laryngeal nerve injury were compared between these two groups of patients. The mortality and the rate of metastasis of tumor were recorded in these two groups of patients after followed -up for 2 to 5 years. Results The operating time in observation group （87. 21 ± 9. 25 min） was significantly longer than that of control group （72. 64 ± 9. 10 min. ） . The number of central lymph nodes dissected in observation group （7. 82 ± 1.32 pieces） was higher than that of control group （5？ 94 ± 1 . 30 pieces） . The rate of 5 years tumor metastasis in patients of observation group （6.25% ） was significantly lower than that of patients in control group （16.67% ） , and the differences was significant （ P 〈 0 . 0 5 ） . There was no significant difference in the amount of bleeding and 5 year mortality between these two groups （ P 〉 0 . 05）. Conclusion Continuous en bloc resection assisted with laparoscopy for surgical treatment of small papillary thyroid carcinoma will extend the operating time, but it does not increase the amount of blood loss, more beneficial to clear foci, in line with the principle of non - tumor, and it may reduce long - term metastasis with good safet

关 键 词：甲状腺微小乳头状癌 腔镜手术 连续整块切除 分块切除 

分 类 号：R736.1[医药卫生—肿瘤]