摘要
目的探讨甲状腺癌局部复发及再手术选择的影响因素。方法收集160例行手术治疗的分化型甲状腺癌(DTC)患者的临床资料,对所有术后患者随访3年,依据术后是否复发将其分为复发组和非复发组。采用多因素Logistic回归模型分析DTC术后局部复发的影响因素。结果截至随访结束,160例DTC术后患者中,局部复发患者32例,未局部复发患者128例。复发与未复发患者的年龄、临床分期、分化程度、淋巴结转移情况比较,差异均有统计学意义(P﹤0.05)。多因素Logistic回归分析结果显示,临床分期、分化程度和淋巴结转移情况均是DTC患者术后局部复发的影响因素(P﹤0.05)。32例DTC术后局部复发患者中,颈淋巴结复发10例,甲状腺复发22例。初次手术方式为甲状腺次全切术的12例患者,复发后行甲状腺残叶切除术+中央区淋巴结清扫术+侧颈部淋巴结清扫术;初次手术方式为甲状腺全切术的6例患者术后发生颈部淋巴结转移,复发后行中央区淋巴结清扫术+侧颈部淋巴结清扫术;初次手术方式为患侧叶加峡部切除术的14例患者,复发后行甲状腺次全切术。术后辅以促甲状腺激素抑制剂为主的综合治疗。结论临床分期、肿瘤分化程度和淋巴结转移情况均是影响甲状腺癌局部复发的重要因素,临床医师应合理认知甲状腺癌,选择恰当的手术方式。
Objective To explore the influencing factors of local recurrence and reoperation choice of thyroid cancer.Method The clinical data of 160 patients with differentiated thyroid cancer(DTC)undergoing surgical treatment were collected.All patients were followed up for 3 years.According to the follow-up results,the patients were divided into recurrent group and non-recurrent group.Multivariate logistic regression model was used to analyze the influencing factors of local recurrence after DTC.Result By the end of follow-up,of 160 patients after DTC,32 had local recurrence and 128 had no local recurrence.There were significant differences in age,clinical stage,differentiation degree and lymph node metastasis between relapsed and non-relapsed patients(P<0.05).Multivariate logistic regression analysis showed that clinical stage,degree of differentiation and lymph node metastasis were important influencing factors of local recurrence in patients with DTC(P<0.05).Among 32 patients with recurrence,there were 10 cases of cervical lymph node recurrence,22 cases of thyroid recurrence.The first operation method was subtotal thyroidectomy in 12 patients,after recurrence,thyroidectomy,central lymph node dissection and lateral neck lymph node dissection were performed.The first operation method was total thyroidectomy in 6 patients with cervical lymph node metastasis after operation,after recurrence,central lymph node dissection and lateral cervical lymph node dissection were performed.14 patients who underwent subtotal thyroidectomy after recurrence were treated with lobectomy plus isthmus resection on the affected side for the first time.After operation,combined therapy with thyroid stimulating hormone inhibitor was supplemented.Conclusion The clinical stage,degree of tumor differentiation and lymph node metastasis are important factors affecting local recurrence of thyroid cancer.Clinicians should reasonably recognize thyroid cancer and choose appropriate surgical methods.
作者
梅刚
刘真
王国兴
MEI Gang;LIU Zhen;WANG Guoxing(Department of General Surgery,Pingdingshan First People’s Hospital,Pingdingshan 467000,He’nan,China)
出处
《癌症进展》
2021年第3期286-289,共4页
Oncology Progress
关键词
分化型甲状腺癌
复发
再手术
临床分期
分化程度
淋巴结转移
影响因素
differentiated thyroid cancer
recurrence
reoperation
clinical stage
degree of differentiation
lymph node metastasis
influencing factor
