摘要
目的 探讨全甲状腺切除联合预防性中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌的临床疗效.方法 将87例患者采用EXCEL随机数字表法按1∶1比例分为治疗组（n=44）和对照组（n=43）.对照组给予患侧腺叶＋峡部切除＋患侧中央区淋巴结清扫术,治疗组给予全甲状腺切除＋预防性中央区淋巴结清扫术.比较两组肿瘤大小、淋巴结受累情况、SF-36评分、并发症及术后复发、转移、病死率.结果 两组肿瘤大小、淋巴结受累情况及并发症差异均无统计学意义（χ2=1.194,P=0.610;χ2=0.680,P=0.500;χ2=0.603,P=0.438）.治疗后两组SF-36评分与治疗前比较均显著升高（t=7.927,P=0.000;t=5.374,P=0.000）;治疗组SF-36评分[（76.47±13.72）]分显著高于对照组的（68.88±15.36）分（t=2.429,P=0.017）.随访半年,治疗组未发现复发患者,对照组发现5例,两组复发率差异有统计学意义（χ2=5.428,P=0.026）;治疗组未发现转移患者,对照组发现6例,两组差异有统计学意义（χ2=6.594,P=0.012）.结论全甲状腺切除联合预防性中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌临床疗效显著,可有效减少肿瘤复发、转移风险,提高患者生活质量,值得推广应用.
Objective To explore the clinical effect of total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma.Methods Using EXCEL random number method according to the proportion of 1︰1,87 patients with multifocal papillary thyroid carcinoma were divided into treatment group（n=44） and control group（n=43）.The control group was treated by ipsilateral lobectomy and isthmus resection and ipsilateral central lymph node dissection,the treatment group was treated by total thyroidectomy plus prophylactic central lymph node dissection.The tumor size,lymph node involvement,the score of SF-36,the complications and the rate of postoperative recurrence,metastasis and mortality of the two groups were compared.Results The tumor size,lymph node involvement and complications in the treatment group had no statistically significant differences compared with the control group（χ2=1.194,P=0.610;χ2=0.680,P=0.500,χ2=0.603,P=0.438）.After treatment,the SF-36 scores of the two groups were significantly higher than before treatment（t=7.927,P=0.000;t=5.374,P=0.000）.The SF-36 score of the treatment group was （76.47±13.72）points,which was significantly higher than （68.88±15.36）points of the control group（t=2.429,P=0.017）.The patients were followed up for 6 months,there was no recurrence in the treatment group,while there were 5 cases in the control group,the difference was statistically significant（χ2=5.428,P=0.026）.There was no metastasis in the treatment group,while there were 6 cases in the control group,the difference was statistically significant（χ2=6.594,P=0.012）.Conclusion Total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma has significant clinical curative effect.It can effectively reduce the risk of tumor recurrence and metastasis and improve the quality of life of patients.It is worthy of popularization and application.
作者
朱涛
Zhu Tao(Department of General Surgery, the Central Hospital of Bao＇an District, Shenzhen, Guangdong 518100, China)
出处
《中国基层医药》
CAS
2017年第13期2034-2037,共4页
Chinese Journal of Primary Medicine and Pharmacy
