单侧甲状腺微小乳头状癌对侧腺体隐匿癌灶的预测因素及手术治疗策略  

Prognostic factors and surgical treatment strategy of occult cancer in the contralateral side of the unilateral papillary thyroid carcinoma

作　　者：李同昌[1] 王彪[1] 段秀庆[1] 

机构地区：[1]哈尔滨医科大学附属第一医院乳腺外科,哈尔滨医学硕士150001

出　　处：《医学研究生学报》2017年第6期641-644,共4页Journal of Medical Postgraduates

摘　　要：目的既往对单侧甲状腺微小乳头状癌(PTMC)的术式仍存在分歧,文中旨在探讨单侧甲状腺微小乳头状癌对侧腺体隐匿癌灶的预测因素,分析比较单侧PTMC的手术方式。方法回顾性分析哈尔滨医科大学附属第一医院乳腺外科2014年01月至2016年01月经术前彩超检查局限于单侧腺体的PTMC患者327例,根据对侧腺体是否存在隐匿癌灶分为单侧腺体癌灶者(n=278)与双侧腺体癌灶者(n=49);根据是否行预防性中央区淋巴结清扫分为淋巴结清扫者(n=117)与淋巴结未清扫者(n=210),进一步分析对侧腺体隐匿癌灶的预测因素及中央区淋巴结预防性清扫术后相关并发症。结果预防性行中央区淋巴结清扫术患者117例中存在中央区淋巴结转移者55例,转移率为47.0%。患侧腺体内多发癌灶是对侧腺体内存在隐匿癌灶的危险因素(OR=4.924,95%CI:1.605~15.107)。淋巴结清扫者和淋巴结未清扫者术后并发症差异无统计学意义(P>0.05)。结论单侧腺体内PTMC多发癌灶可以帮助预测对侧腺体隐匿癌灶的存在,并且中央区淋巴结转移率较高,建议对于单侧腺体内多发癌灶的PTMC行甲状腺全切除术+中央区淋巴结预防性清扫术。Objective Previously, there was an argument on the surgery way of unilateral papillary thyroid microcarcinoma （PTMC）. The purpose of this study was to investigate the predictive factors of occult thyroid carcinoma in unilateral thyroid papillary microcarcinoma, and to compare the surgical methods of unilateral thyroid papillary microcarcinoma. Methods We retrospective an- alyzed 327 cases of unilateral PTMC patients confirmed by preoperative color Doppler ultrasound examination from January 2014 to Jan- uary 2016 in Department of Breast Surgery, First Affiliated Hospital of Harbin Medical University. According to the presence of occult cancer, patients were divided into unilateral glandular loci （n = 278） and bilateral glandular loci （n = 49） ; according to whether carry out the prevention of central lymph node dissection, patients were divided into lymph node dissection（ n = 117） and without lymph nodedissection （n = 210） to further analyze the predictive factors of contralateral gland occult cancer and postoperative complications of preventive central lymph node dissection. Results 55 cases had central lymph node metastasis in 117 cases with lymph node dissec- tion, the metastasis rate was 47.0%. The multiple foci in the ipsilater-al gland is a risk factor for the presence of occult foci in the contralateral gland （OR= 4.924, 95%CI： 1.605 - 15.107）. There was no significant difference in postoperative complications between lymph node dissection and without lymph node dissection （P〉0.05）. Conclusion multiple foci in the unilateral thyroid papillary thyroid microcarcinoma can help us to predict the contralateral gland occult cancer, and the central lymph node metastasis rate is higher, therefore, for the unilateral glands of multiple tumors in the papillary thy- roid microcarcinoma, we recommended the total thyroidectomy＋prophylactic central lymph node dissection surgery way.

关 键 词：甲状腺微小乳头状癌 隐匿癌灶 预测因素 

分 类 号：R736.1[医药卫生—肿瘤]