天津医药

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c0N甲状腺乳头状癌手术方案选择临床

张强1,张仑1,张文超2,3,姚晓峰2,4,徐本义1,2,陈可欣2,5   

  1. 1. 天津医科大学附属肿瘤医院
    2.
    3. 天津医科大学附属肿瘤医头颈一科
    4. 天津医科大学附属肿瘤医院头颈一科
    5. 天津医科大学附属肿瘤医院流行病室
  • 收稿日期:2010-10-14 修回日期:2011-06-28 出版日期:2011-12-15 发布日期:2011-12-15
  • 通讯作者: 张仑

Clincle analysis on selection of surgical operation for Clincle stage N0 papillary thyroid carcinoma

  • Received:2010-10-14 Revised:2011-06-28 Published:2011-12-15 Online:2011-12-15

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摘要： 目的：探讨甲状腺乳头状癌（PTC）临床淋巴结阴性（cN0）患者手术方案选择。方法：分析2007年1月—2010年1月127例cN0 PTC患者临床资料，根据术前临床分期及术中冰冻病理分期，113例选择性颈部淋巴结清扫术：中央区淋巴结清扫术44例，扩大中央区淋巴结清扫术13例，功能性颈部淋巴结清扫术56例。分析比较淋巴结转移情况和各组淋巴结转移间的关系。结果：清扫淋巴结病理检查示隐性转移率36.3%（41/113）；不同肿瘤侵犯范围和年龄的Ⅵ区淋巴结转移率差异有统计学意义（均P<0.05）；不同性别及体质量指数的Ⅵ区淋巴结转移率间差异无统计学意义（P＞0.05）；Ⅱ～Ⅳ区淋巴结转移与Ⅵ区淋巴结转移情况存在相关性（r=0.388，P <0.01）。结论：cN0 PTC患者应行中央区淋巴结清扫术，对高危转移患者可考虑扩大中央区淋巴结清扫术。

关键词: 腺癌, 乳头状, 癌, 乳头状, 甲状腺肿瘤, 颈淋巴结清扫术, 淋巴转移, 生活质量

Abstract: Abstract Objective Talk about the selection of surgical operation for clincle stage N0(cN0) papillary thyroid carcinoma (PTC), in order to ensure the quality of life patients . Methords 127 cases of PTC with cN0, 71cases with thyroid lobectomy and isthmus lobectomy, 56 cases with the glands resection.113 cases underwent selective lymphadenectomy,44 cases with central lymph node dissection 13 cases with expansion of the Central lymph node dissection, 56 cases with functional neck lymph node dissection. Compared the differences between the various sets of data with chi-square test .Results In 113 cases，36.3%（41/113）of all cases showed implicit lymph nodes metastasis. One case got injury of laryngeal recurrence nerve on account of the tumor invasion. No one got seizures occur with permanent hypocalcemia. Statistics analysis shows that : Ⅱ ~ Ⅳ lymph node metastasis rate was difference between Ⅵ lymph node negative and the positive groups. The difference was significant (P <0.05).The extent of tumor invasion(within cancer capsule, the invasion of the capsule, the invasion of the gland) and the age group （＜45years，≥45years）with Ⅵ lymph node metastasis（P＜0.05）was statistically significant. Body mass index(BMI) and gender with Ⅵ lymph node metastasis（P＜0.05）was not statistically significant. Conlusion The larger extent of tumor invasion and the young age may likely to get lymph nodes metastasis. Patients with cN0 PTC shoude performed central lymph node dissection, further more , to the high-risk patients, we should consider expansion of the central lymph node dissection.

Key words: 生活质量