甲状腺系膜切除术对甲状腺癌病人生存率影响  

Effect of mesangial thyroid resection on survival rate in patients with thyroid cancer

作　　者：杨炳石 闫桂玲 黄燕 江志静 YANG Bingshi;YAN Guiling;HUANG Yan(Department of General Surgery,Naval Hospital of Eastern Theater,Zhoushan,Zhejiang 316000,China)

机构地区：[1]东部战区海军医院普外神外科,浙江舟山316000

出　　处：《临床外科杂志》2020年第3期236-239,共4页Journal of Clinical Surgery

摘　　要：目的探讨甲状腺系膜切除术在甲状腺乳头状癌病人中央区淋巴结清扫中的临床效果及其对远期预后影响。方法 2015年12月30日~2019年1月30日在我院行甲状腺癌根治术的甲状腺乳头状癌病人105例。根据治疗方法不同分为两组,观察组35例,行甲状腺系膜切除术;对照组70例,行常规中央淋巴结清扫。比较两组病人手术指标、术后并发症发生率以及手术后血清甲状旁腺激素(PTH)、血钙水平。随访至2019年12月,随访终点为死亡,观察中央区淋巴结清扫方式对生存率的影响。结果观察组手术时间长于对照组,差异有统计学意义(P<0.05)。两组术中出血量、术后住院时间及术后下床活动时间比较差异无统计学意义(P>0.05)。两组手术前、术后第1、3天血清PTH、血钙比较差异无统计学意义(P>0.05)。两组术后第1天血清PTH、血钙低于术前,术后第3天血清PTH低于术前,差异有统计学意义(P<0.05)。两组术后喉反神经暂时损伤、喉反神经永久损伤、切口感染、术后出血、总并发症、二次手术发生率差异均无统计学意义(P>0.05)。随访时间12~48个月,中位随访时间为36.9个月。Kaplan-Meier分析并Log-rank检验显示,甲状腺系膜切除病人累积生存率高于非系膜切除病人(P<0.05)。多因素分析结果显示,TNM分期、腺外侵犯、淋巴结转移、甲状腺系膜切除是生存率的独立预后因素(P<0.05)。结论甲状腺系膜切除术短期效果与常规中央区淋巴结差别不大,但远期死亡率低,预后较好。Objective To investigate the effect of mesangial thyroid resection in patients with papillary thyroid carcinoma and its effect on long-term prognosis.Methods A total of 105 patients with thyroid papillary carcinoma who underwent radical thyroidectomy from December 30,2015 to January 30,2019 were enrolled.Among them,35 patients underwent mesangial thyroid resection(observation group),70 patients underwent conventional central lymph node dissection(control group).The surgical indexes,postoperative complications,and postoperative serum parathyroid hormone(PTH)and serum calcium levels were compared between the two groups.The deadline of follow-up time was December 2019,the end of follow-up was death,and the effect of lymph node dissection and clinicopathological data on death rate was observed.Results The operation time of the observation group was longer than that of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the amount of intraoperative blood loss,postoperative hospital stay,and time to get out of bed after surgery between the two groupst(P>0.05).There were no significant differences in serum PTH and serum calcium between the two groups before and after surgery(P>0.05).Serum PTH and serum calcium were lower in two groups on the first day after operation than that before surgery,and the serum PTH was lower in two groups on the third day after operation than that before surgery(P<0.05).There were no significant differences in the incidence of postoperative laryngeal nerve injury,permanent laryngeal nerve injury,wound infection,postoperative bleeding,total complications,and secondary surgery in two groups(P>0.05).The follow-up time was 12~48 months and the median follow-up time was 36.9 months. Kaplan-Meier analysis and Log-ranktest showed that the cumulative survival rate of patients with mesangial thyroid resection was higher than that of patients with non-mesangial thyroid resection(P<0.05).Multivariateanalysis showed that TNM staging,extra-glan

关 键 词：甲状腺系膜切除术 甲状腺乳头状癌 中央区淋巴结 

分 类 号：R736.1[医药卫生—肿瘤]