单侧甲状腺乳头状癌伴同侧颈侧区淋巴结转移:腺叶切除还是全甲状腺切除?  

Lobectomy vs.total thyroidectomy for unilateral papillary thyroid carcinoma with ipsilateral cervical lymph node metastasis

作　　者：章诗佳 周珂慧 赵明 毛晓春 赏金标 兰霞斌 Zhang Shijia;Zhou Kehui;Zhao Ming;Mao Xiaochun;Shang Jinbiao;Lan Xiabin(Postgraduate Training Base Alliance of Wenzhou Medical University(Zhejiang Cancer Hospital),Hangzhou 310022,China;Department of Thyroid Surgery,Zhejiang Cancer Hospital,Hangzhou Institute of Medicine(HIM),Chinese Academy of Sciences 310022,China)

机构地区：[1]温州医科大学研究生培养基地(浙江省肿瘤医院),浙江省肿瘤医院甲状腺外科,杭州310022

出　　处：《中华内分泌外科杂志(中英文)》2025年第1期57-62,共6页Chinese Journal of Endocrine Surgery

基　　金：浙江省卫健委医药卫生科技项目(2023RC138,2022PY005,2020KY482);浙江省自然科学基金(LY24H160019)。

摘　　要：目的:本研究旨在比较单侧甲状腺乳头状癌(PTC)伴同侧颈侧区淋巴结转移(LLNM)患者原发灶行单侧腺叶切除(+峡部切除)或全(近全)甲状腺切除术时在预后等方面的风险与获益,从而找出针对这些患者的最佳手术方案。方法:回顾性分析2012年2月至2020年1月在浙江省肿瘤医院甲状腺外科行初次手术治疗的单侧PTC伴同侧LLNM的病例共505例。根据原发灶切除范围分成单侧腺叶切除术组(314例)和全甲状腺切除术组(191例),并使用倾向性评分匹配(PSM)消除两组的潜在混淆偏差后,筛选出177对病例,分析两组的无复发生存期(RFS)、总生存期(OS)、住院费用及术后并发症等临床结果差异。结果:PSM后,全甲状腺切除术组的术后并发症发生率为37.3%(66例),单侧腺叶切除术组的术后并发症发生率为3.4%(6例),主要表现为暂时性甲状旁腺功能减退(HP)。虽两组的住院时长差异无统计学意义(P=0.792),但与全甲状腺切除术组相比,单侧腺叶切除术组的患者所用的手术时间更少(P<0.001),住院费用和手术费用更少(P<0.0001),术后1个月的左甲状腺素(L-T4)服用剂量也相对较小(P<0.0001)。单因素分析显示,LLNM数目、总淋巴结转移(LNM)率、LLNM率和T分期是复发的显著风险因素;多因素分析显示,T分期是复发风险因素。中位随访60个月,范围为3~138个月后,单侧腺叶切除术组有19例(10.7%)复发,全甲状腺切除术组有11例(6.2%)复发,两组的差异无统计学意义(P=0.133)。OS曲线显示单侧腺叶切除术组和全甲状腺切除术组无明显差异(P=0.740)。结论:对无其他高危风险特征的单侧PTC伴同侧LLNM的患者,原发灶手术可选择单侧腺叶切除术。Objective:To compare the benefits and prognostic risks of unilateral lobectomy(with or without isthmusectomy)or total(or near-total)thyroidectomy for primary foci of unilateral papillary thyroid cancer(PTC)patients with ipsilateral lateral cervical lymph node metastasis(LLNM),so as to find out the optimal surgery for these patients.Methods:A total of 505 unilateral PTC patients with ipsilateral LLNM who underwent initial surgical treatment at the Thyroid Surgery Department of Zhejiang Cancer Hospital from Feb.2012 to Jan.2020 were retrospectively reviewed.The patients were divided into unilateral lobectomy group(n=314)and total thyroidectomy group(n=191)according to the extent of resection of primary foci.Then 177 pairs of cases were screened out after eliminating the potential confounding bias between the two groups by using propensity score matching(PSM),analyzing the differences in clinical outcomes such as recurrence-free survival(RFS),overall survival(OS),hospitalization costs,and postoperative complications between the two groups.Results:After PSM,the postoperative complication rate was 37.3%(n=66)in the total thyroidectomy group and 3.4%(n=6)in the unilateral lobectomy group.The complication was mainly characterized by temporary hypoparathyroidism(HP).Although the difference in length of hospitalization between the two groups was not statistically significant(P=0.792),patients in the unilateral lobectomy group used less surgical time(P<0.001),had lower hospitalization and surgical costs(P<0.0001),and took a relatively smaller dose of levothyroxine(L-T4)one month after the operation(P<0.0001),as compared with the total thyroidectomy group.Univariate analysis showed that the number of LLNM total lymph node metastasis(LNM)rate,LLNM rate,and T stage were significant risk factors for relapse.Multi-factor regression analysis indicated that T-staging was a risk factor for recurrence.After a median follow-up of 60(3-138)months,19 patients(10.7%)in the unilateral lobectomy group and 11 patients(6.2%)in the total th

关 键 词：单侧腺叶切除术 全甲状腺切除术 甲状腺乳头状癌 倾向性评分匹配 无复发生存期 

分 类 号：R73[医药卫生—肿瘤]