改良Miccoli手术治疗分化型甲状腺癌的疗效及术后复发的相关因素分析  

Effect of modified Miccoli’s surgery in differentiated thyroid cancer and related factors of recurrence after operation

作　　者：汪鑫[1] 武晓娜 曹力钒 邱书变 邢珂 WANG Xin;WU Xiaona;CAO Lifan;QIU Shubian;XING Ke(Department of Thyroid and Mammary Surgery,Nanyang Second General Hospital,Nanyang 473000,He’nan,China)

机构地区：[1]南阳市第二人民医院甲状腺乳腺外科

出　　处：《癌症进展》2020年第2期172-175,共4页Oncology Progress

摘　　要：目的探究改良Miccoli手术治疗分化型甲状腺癌的疗效及术后复发的影响因素。方法按照治疗方案的不同将320例分化型甲状腺癌患者分为对照组(接受传统甲状腺切除术)和观察组(接受改良Miccoli手术),各160例。比较两组患者的手术相关指标和术后并发症发生情况,分析分化型甲状腺癌术后复发的影响因素。结果观察组患者的术中出血量、术中引流量均明显少于对照组,切口长度、手术时间和住院时间均明显短于对照组(P﹤0.01)。术后,观察组患者的并发症总发生率低于对照组(P﹤0.05)。单因素分析结果显示,复发组与未复发组患者在肿瘤最大径、手术方式和是否进行过淋巴清扫方面的构成比比较,差异均有统计学意义(P﹤0.05)。多因素Cox比例风险模型回归分析结果显示,肿瘤最大径≥2 cm、行传统甲状腺切除术和未行淋巴清扫是分化型甲状腺癌术后复发的独立危险因素(P﹤0.05)。结论改良Miccoli手术治疗分化型甲状腺癌具有术中出血量少、组织损伤小、术后并发症发生率低的特点。肿瘤最大径≥2 cm、行传统甲状腺切除术和未行淋巴清扫是分化型甲状腺癌术后复发的危险因素。Objective To explore the effect of modified Miccoli’s surgery in differentiated thyroid cancer and the related factors of recurrence after operation.Method By differing surgical procedures,320 patients with differentiated thyroid cancer were divided into control group or study group,receiving traditional thyroidectomy or modified Miccoli’s surgery,with 160 cases in each,respectively.The surgical indicators and postoperative complications in the two groups were compared,and the risk factors affecting the recurrence of differentiated thyroid cancer after operation were analyzed.Result The intraoperative blood loss,intraoperative drainage volume were less,and the length of incision,operative time,and hospitalization time in study group were significantly shorter compared to control group(P<0.01).After surgery,the incidence rate of complications in study group was significantly lower than that in control group(P<0.05).Univariate analysis showed that,between the subgroups of patients with recurrence and non-recurrence,statistically significant differences were noted in regard to maximum tumor size,surgical regimen,and history of lymph node dissection(P<0.05).Multivariate Cox proportional hazard model indicated that the maximum tumor diameter≥2 cm,traditional thyroidectomy and non-lymph dissection were risk factors for postoperative recurrence of thyroid cancer(P<0.05).Conclusion Modified Miccoli’s surgery is characterized,in the treatment of differentiated thyroid cancer,with less intraoperative blood loss,minor damage to tissues,and lower incidence of complications.The risk factors for recurrence of thyroid cancer after operation include the maximum tumor diameter≥2 cm,administration of traditional thyroidectomy and no prior lymph node dissection.

关 键 词：甲状腺癌 疗效 复发 改良Miccoli手术 并发症 

分 类 号：R736.1[医药卫生—肿瘤]