双侧中央区淋巴结清扫术在分化型甲状腺癌手术治疗中的应用研究  

Application of Bilateral Central Lymph Node Dissection in the Surgical Treatment of Differentiated Thyroid Cancer

作　　者：林乐真 欧文勇 温明辉 罗文 邓兆森 罗秋荣 LIN Lezhen;OU Wenyong;WEN Minghui;LUO Wen;DENG Zhaosen;LUO Qiurong(Department of Nail and Breast Surgery,Fujian Longyan People's Hospital,Longyan 364000,Fujian,China)

机构地区：[1]福建省龙岩人民医院甲乳外科,福建龙岩364000

出　　处：《中外医疗》2024年第24期55-58,共4页China & Foreign Medical Treatment

摘　　要：目的 探讨分化型甲状腺癌患者手术中开展双侧中央区淋巴结清扫的临床作用价值。方法 方便选取2019年1月—2021年1月福建省龙岩人民医院收治的94例未明确检出淋巴结转移或已经检测为阴性的分化型甲状腺癌患者为研究对象,按照手术方法不同分为两组。对照组(n=47)在单侧腺叶切除术中开展同侧中央区淋巴结清扫,研究组(n=47)在甲状腺全切术中开展双侧中央区淋巴结清扫。比较两组淋巴结清扫数目、血钙水平变化及术后3年期侧颈方向淋巴结转移率及并发症发生情况。结果 研究组的淋巴结清扫数目为(11.62±3.29)个,高于对照组的(9.47±3.31)个,差异有统计学意义(t=3.158,P<0.05)。研究组术后3年期侧颈淋巴结转移率为2.13%(1/47),低于对照组的17.02%(8/47),差异有统计学意义(χ^(2)=4.424,P<0.05)。两组患者的术后血钙水平均明显下降,且研究组低于对照组,差异有统计学意义(P均<0.05)。两组并发症发生率对比,差异无统计学意义(P>0.05)。结论 针对分化型甲状腺癌患者,通过在甲状腺全切术中开展双侧中央区淋巴结清扫治疗,有利于扩大淋巴结清扫范围、降低3年期侧颈方向淋巴结转移率,但术后血钙水平更低,应注意通过补充钙剂或维生素D等方式降低低钙血症的发生率。Objective To investigate the clinical value of bilateral central lymph node dissection in patients with differentiated thyroid cancer.Methods From January 2019 to January 2021,94 patients with differentiated thyroid cancer who were not clearly detected with lymph node metastasis or had been detected as negative in Longyan People's Hospital of Fujian Province were conveniently selected as the research objects,and divided into two groups according to different surgical methods.The control group(n=47)underwent ipsilateral central lymph node dissection during unilateral lobectomy,and the study group(n=47)underwent bilateral central lymph node dissection during total thyroidectomy.The number of lymph node dissection,the change of serum calcium level,the rate of lateral cervical lymph node metastasis 3 years after operation and the incidence of complications in the two groups were compared.Results The number of lymph node dissection in the study group was(11.62±3.29),which was higher than that in the control group(9.47±3.31),and the difference was statistically significant(t=3.158,P<0.05).The rate of lateral cervical lymph node metastasis 3 years after operation in the study group was 2.13%(1/47),which was lower than 17.02%(8/47)in the control group,and the difference was statistically significant(χ^(2)=4.424,P<0.05).The postoperative serum calcium levels of the two groups were significantly decreased,and the study group was lower than the control group,the difference was statistically significant(all P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion For patients with differentiated thyroid cancer,bilateral central lymph node dissection during total thyroidectomy is beneficial to expand the scope of lymph node dissection and reduce the rate of 3-year lateral cervical lymph node metastasis.However,postoperative serum calcium levels is lower.Attention should be paid to reducing the incidence of hypocalcemia by supplementing calcium or vitamin D.

关 键 词：甲状腺癌 分化型 甲状腺全切 双侧中央区淋巴结清扫术 淋巴结转移 

分 类 号：R581[医药卫生—内分泌]