甲状腺癌术后肺部改变分析  

Experience in diagnosis and treatment of pulmonary changes after radical surgery for thyroid cancer

作　　者：梁青壮 李朋[1] 易辛[1] 徐露[2] 贾浩 朱丽璋 韦伟[1] Liang Qingzhuang;Li Peng;Yi Xin;Xu Lu;Jia Hao;Zhu Lizhang;Wei Wei(Department of Breast and Thyroid Surgery,Shenzhen Hospital,Peking University,Shenzhen 518036,China;Department of Radiology,Shenzhen Hospital,Peking University,Shenzhen 518036,China)

机构地区：[1]北京大学深圳医院甲状腺乳腺外科,518036 [2]北京大学深圳医院影像科,518036

出　　处：《中华内分泌外科杂志》2021年第1期52-55,共4页Chinese Journal of Endocrine Surgery

基　　金：深圳市三名工程项目资助(SZSM201612010);深圳市医学重点学科建设经费资助。

摘　　要：目的探讨甲状腺癌患者术后肺部改变的原因及诊治方法。方法回顾分析北京大学深圳医院甲乳外科2019年10月1日至2020年1月31日收治的甲状腺癌手术患者378例,依据年龄、性别、抽烟史、身体质量指数、手术方式、手术入路进行分组,采用SPSS 23.0软件统计分析不同因素对术后肺部改变的影响,两组计数资料的比较采用χ2检验法。结果患者年龄、性别、有无吸烟史及手术入路对术后是否发生肺部改变无明显影响(P>0.05)。行甲状腺癌根治术组共312例,共发生肺部改变4例,行甲状腺癌根治术+侧颈清扫术组共66例,共发生肺部改变10例,两组的肺部改变发生率差异有统计学意义(P=0.001)。行甲状腺癌根治术+侧颈清扫术组中,左侧颈清扫组共19例,发生肺部改变1例;右侧颈清扫组共34例,发生肺部改变4例;双侧颈部清扫组13例,发生肺部改变5例,三组的肺部改变发生率差异有统计学意义(P=0.027)。偏瘦组共24例,有2例发生肺部改变;体重正常组共212例,有4例发生肺部改变;超重组共109例,有4例发生肺部改变;肥胖组共33例,有4例发生肺部改变;4组的肺部改变发生率差异有统计学意义(P=0.019)。结论侧颈部清扫术及患者的身体质量指数是影响甲状腺癌患者术后出现肺部改变的重要因素,行侧颈部清扫术的甲状腺癌患者术后应积极通过胸片排查其肺部改变情况,特别是针对双侧颈部清扫,或偏瘦及肥胖的患者。Objective To investigate the causes,diagnosis and treatment of postoperative pulmonary changes in patients with thyroid cancer.Methods Data of 378 patients with thyroid cancer surgery admitted from Oct.1,2019 to Jan.31,2020 were retrospectively analyzed.SPSS 23.0 statistical software was adopted to analyze the effect of gender,age,smoking history,BMI.operation way and the surgical approach on postoperative changes in the lungs.The two groups of counting data were compared using X^(2) method.Results Age,gender,smoking history and surgical approach had no significant influence on postoperative pulmonary change(P>0.05).Lung changes in patients receiving thyroid cancer plus lateral neck dissection were greater than those receiving radical thyroid cancer alone(P=0.001),and lung changes in patients receiving bilateral neck dissection were greater than those receiving unilateral neck dissection(P=0.027).The pulmonary changes in patients with underweight and obesity were greater than those in patients with normal weight and hyperreorganization(P=0.019).Conclusions Lateral neck dissection and patients*body mass index are important factors affecting the postoperative lung changes in thyroid cancer patients.Thyroid cancer patients undergoing lateral neck dissection should actively check their lung changes through chest radiographs after surgery,especially for lean and obese patients,and patients undergoing bilateral neck dissection.

关 键 词：甲状腺癌 甲状腺癌根治术 侧颈部清扫术 肺部改变 

分 类 号：R653[医药卫生—外科学] R736.1[医药卫生—临床医学]