双侧中央区淋巴结清扫术在单侧分化型甲状腺癌手术治疗中的应用效果  

Application Effect of Bilateral Central Neck Lymph Node Dissection in the Surgical Treatment of Unilateral Differentiated Thyroid Carcinoma

作　　者：姬明镝 JI Mingdi(Department of General surgey,Fangcheng County People's Hospital,Nanyang Henan 473200,China)

机构地区：[1]方城县人民医院普外科,河南南阳473200

出　　处：《临床研究》2025年第5期17-21,共5页Clinical Research

摘　　要：目的探讨双侧中央区淋巴结清扫术在单侧分化型甲状腺癌(DTC)手术治疗中的应用效果,为临床提供参考。方法回顾性分析2019年9月至2024年9月方城县人民医院收治的86例单侧DTC患者的临床资料,根据治疗方案的不同分为对照组(单侧甲状腺切除术^(+)同侧中央区淋巴结清扫术)与研究组(单侧甲状腺切除术^(+)双侧中央区淋巴结清扫术),各43例。比较两组患者手术指标、甲状旁腺激素(PTH)、血钙、甲状腺球蛋白(Tg)水平、术后疼痛程度、免疫功能、并发症发生情况及中央区淋巴结转移情况。结果研究组患者手术时长更长、出血量更多,差异有统计学意义(P<0.05)。术后,两组患者PTH、血钙及Tg水平降低,且研究组低于对照组,差异有统计学意义(P<0.05)。术后,两组患者CD4^(+)、CD8^(+)T淋巴细胞百分比水平低于术前,且研究组低于对照组,差异有统计学意义(P<0.05)。两组患者并发症发生率比较,差异无统计学意义(P>0.05)。两组患者同侧淋巴结转移率比较,差异无统计学意义(P>0.05);研究组患者对侧淋巴结转移率为0。结论对单侧DTC患者予以预防性双侧中央区淋巴结清扫术干预,可能增加手术时长与出血量、甲状腺与甲状旁腺功能损伤程度,但对住院时间、术后疼痛、术后并发症无明显影响。双侧清扫术虽可清除对侧潜在转移淋巴结,但因单侧DTC对侧转移率低,其临床获益有限。Objective To explore the application effect of bilateral central neck lymph node dissection in the surgical treatment of unilateral differentiated thyroid carcinoma(DTC),providing a reference for clinical practice.Methods A retrospective analysis was conducted on the clinical data of 86 patients with unilateral DTC treated at Fangcheng County People's Hospital from September 2019 to September 2024.Based on different treatment plans,patients were divided into the control group(unilateral thyroidectomy^(+)ipsilateral central neck lymph node dissection)and the study group(unilateral thyroidectomy^(+)bilateral central neck lymph node dissection),with 43 cases in each group.The surgical indicators,parathyroid hormone(PTH),serum calcium,thyroglobulin(Tg)levels,postoperative pain level,immune function,incidence of complications,and central neck lymph node metastasis were compared between the two groups.Results The patients in the study group had longer surgical duration and greater blood loss,with statistically significant differences(P<0.05).Postoperatively,PTH,serum calcium,and Tg levels decreased in both groups,and the levels in the study group were lower than those in the control group,with statistically significant differences(P<0.05).Postoperatively,the percentages of CD4^(+)and CD8^(+)T lymphocytes were lower than preoperative values in both groups,and the levels in the study group were lower than those in the control group,with statistically significant differences(P<0.05).The comparison of complications showed no statistically significant difference between the two groups(P>0.05).The rates of lymph node metastasis on the ipsilateral side were comparable,with no statistically significant difference(P>0.05);the metastasis rate of lymph nodes on the contralateral side in the study group was 0.Conclusion Preventive bilateral central neck lymph node dissection in patients with unilateral DTC may increase surgical duration and blood loss,as well as the degree of injury to thyroid and parathyroid function,but has no s

关 键 词：分化型甲状腺癌 中央区淋巴结清扫术 甲状旁腺激素 甲状腺球蛋白 疼痛程度 

分 类 号：R736.1[医药卫生—肿瘤]