甲状腺偶发癌的临床病理特征分析  

Clinicopathologic features of thyroid incidental cancer

作　　者：张传灼 高国宇[1] 任明[1] ZHANG Chuanzhuo;GAO Guoyu;REN Ming.(Department of General Surgery,Jiangsu Traditional Chinese Medicine Hospital ,Nanjing 221000, China)

机构地区：[1]江苏省中医院普外科,南京221000

出　　处：《临床外科杂志》2018年第5期360-362,共3页Journal of Clinical Surgery

摘　　要：目的分析甲状腺偶发癌发生的相关因素。方法选取病人68例,术前明确或高度怀疑仅甲状腺一侧腺叶癌灶,而对侧腺叶无结节或者结节不怀疑癌,且手术方式为双侧甲状腺全切+颈部淋巴结清扫术。依据术后对侧腺叶有无癌灶分为偶发癌组和无偶发癌组。分析偶发癌发生的相关因素。结果单因素分析显示偶发癌组与无偶发癌组间性别、年龄、颈部淋巴结肿大、原发癌结节直径、原发癌灶直径、癌灶/结径比、侧颈区淋巴结转移比较,差异无统计学意义(P>0.05);合并癌、合并桥本病、促甲状腺激素(TSH)升高、原发癌位置、原发癌单/多灶、突出包膜、中央区淋巴结转移比较,差异有统计学意义(P<0.05);多因素分析表明,TSH升高及原发癌多灶是偶发癌的独立危险因素;两组间原发癌对侧腺叶结节直径比较,差异有统计学意义(P<0.05),对侧结节单/多灶比较,差异无统计学意义(P>0.05)。结论术前明确或高度怀疑仅有一侧腺叶癌灶,在原发癌多灶和TSH升高时,对侧腺叶发生偶发癌风险增加,手术时需注意。Objective To analyze the related factors of thyroid incidental cancer. Methods A total of 68 patients were selected. They were with preoperative definite or highly suspected adenocarcinoma of one side thyroid gland,while the lateral was without nodules or nodules were not suspected. They were received total thyroidectomy or lymphadenectomy of cervical lymph node in Department of General Surgery,Jiangsu Traditional Chinese Medicine Hospital between 2016-07 and 2017-07. They were divided into incidental papillary carcinoma group and non-incidental papillary carcinoma group. The related factors of thyroid incidental cancer were analyzed. Results There were no statistically significant differences in gender（ P = 1. 000）,age（ P = 0. 750）,cervical lymph node enlargement（ P = 1. 000）,diameter of primary cancer nodule（ P = 0. 910）,diameter of primary carcinoma（ P = 0. 660）,the ratio of carcinoma and nodule（ P = 0. 560） and lateral cervical lymph node metastasis（ P = 1. 000） between the two groups. There were statistically significant differences in complicating with other carcinoma（ P = 0. 038）,Hashimoto＇s thyroiditis（ P = 0. 013）,increase of TSH（ P = 0. 003）,the location of primary carcinoma（ P = 0. 038）,multiple or single of primary carcinoma（ P = 0. 014）,infringement of coated（ P = 0. 021） and center cervical lymph node metastasis（ P = 0. 044）. The analysis showed that the increase of TSH and multiple primary carcinomas were the independent risk factors for IPC. There was significant difference between the two groups in diameter of the contralateral nodules（ P = 0. 016）. There was no significant difference in multiple or single of the contralateral nodules（ P = 1. 000）. Conclusion In the cases with preoperative definite or highly suspected adenocarcinoma of one side thyroid gland accompanied with increasing of TSH and multiple primary carcinomas,an increased risk of incidental cancer in the lateral adenocarcinoma should be paid attention.

关 键 词：偶发癌 桥本甲状腺炎 促甲状腺激素 全甲状腺切除术 

分 类 号：R736.1[医药卫生—肿瘤]