甲状腺乳头状癌规范化手术治疗的临床特点分析  

Clinical characteristics of standardized surgical treatment for patients with papillary thyroid carcinoma

作　　者：崔科英[1] 何建苗[1] 邱啸臣 翁剑锋 CUI Ke-ying;HE Jian-miao;QIU Xiao-chen;WENG Jian-feng(Department of General Surgery,the Eighth Medical Center of Chinese PLA General Hospital,Beijng 100091,China)

机构地区：[1]解放军总医院第八医学中心普通外科

出　　处：《解放军医学杂志》2019年第11期964-967,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨甲状腺乳头状癌规范化手术治疗的临床特点。方法回顾性分析2017年1月-2018年12月于解放军总医院第八医学中心普通外科初治的61例经规范化手术治疗的甲状腺乳头状癌患者的临床资料。61例中,男17例,女44例,年龄21~73(46.4±11.6)岁,均为初次手术治疗,且术后经常规病理证实为甲状腺乳头状癌。结果所有患者术前均行甲状腺高分辨率超声检查,并根据甲状腺影像报告和数据系统(TI-RADS)进行分级,其诊断敏感性为83.6%(51/61)。所有患者均接受规范的手术治疗,其中甲状腺全切术+中央区淋巴结清扫术+侧颈区淋巴结清扫术8例,甲状腺全/近全切术+中央区淋巴结清扫术43例,患侧腺叶及峡部切除术+中央区淋巴结清扫术10例。26例(42.6%)患者发生颈部中央区淋巴结转移,其中8例患者同时伴有侧颈区淋巴结转移。多灶性病变、局部侵犯、肿瘤最大径>1 cm的患者更易发生颈部淋巴结转移(P<0.05),其中央区淋巴结转移率分别为57.7%(15/26)、66.7%(10/15)、64.7%(11/17)。术后出现喉返神经损伤3例(4.9%),暂时性甲状旁腺功能减退18例(29.5%)。结论规范化的术前超声评估及外科治疗可以安全、有效、彻底地切除病灶,减少并发症,提高生活质量,对甲状腺乳头状癌患者有重要意义。Objective To investigate the clinical characteristics of standardized surgical treatment for papillary thyroid carcinoma(PTC). Methods Sixty-one patients with PTC treated by standardized surgery during Jan. 2017 to Dec. 2018 in the Eighth Medical Center of PLA General Hospital were retrospectively analyzed. Among the 61 patients, 17 were male and 44 were female, aged from 21 to 73 years [(46.4±11.6) years]. All the patients were treated with primary surgery, and the papillary carcinoma of thyroid was confirmed by routine pathology after surgery. Results All the patients with PTC underwent thyroid highresolution ultrasound examination before surgical treatment, and were graded according to the thyroid image reporting and data system(TI-RADS). The sensitivity of thyroid ultrasound was 83.6%(51/61). All the patients were managed by the standardized surgical treatment. Eight patients had total thyroidectomy and central and lateral cervical lymph node dissection. Forty-three patients underwent total or nearly total thyroidectomy and central neck lymph node dissection. Ten patients had lateral thyroid lobectomy and isthmus resection and ipsilateral central cervical lymph node dissection. Twenty-six patients(42.6%) had lymph node metastasis in the central region of the neck, of who 8 had lateral cervical lymph node metastasis. The statistical analysis showed that cervical lymph node metastasis was more likely to occur in patients with multifocality, local invasion, and tumor with a maximum diameter >1 cm(P<0.05). The central lymph node metastasis rate was 57.7%(15/26), 66.7%(10/15), and 64.7%(11/17), respectively. Postoperative recurrent laryngeal nerve injury occurred in 3 cases(4.9%). Eighteen patients(29.5%) had postoperative transient hypoparathyroidism. Conclusions Standardized preoperative ultrasound examination and surgical treatment could safely, effectively and completely remove the lesion, reduce complications and improve the quality of life, which is of great significance for patient with papillary thyroid c

关 键 词：甲状腺肿瘤 外科手术 淋巴转移 超声检查 

分 类 号：R736.1[医药卫生—肿瘤]