甲状腺乳头状癌手术方式与预后的分析

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1、维普资讯http://www.cqvip.com443【文章编号】0258—5898(2004)06—0443—03·临床研究·甲状腺乳头状癌手术方式与预后的分析翁子毅，费哲为，吴克瑾，吴增斌，李方明，全志伟(上海第二A医科大学新华医院普外科，上海200092)a【摘要】目的探讨甲状腺乳头状癌(PTC)}术切除范围Lj预后的关系。方法对124例经手术、病理证实的PTC患者进七行随访。根据分组与手术方式、术后复发和生存率进行比较，行Wilcoxon(Gehan)统计分析和x‘检验。结果1．低危组淋巴海结转移率明显低于高危组(P：0．013)。而隐灶癌明显低于其他PTC，

2、两者比较有显著差异(P=0．008)2．低危组5年无瘤第生存率同高危组比较，明显高于高危组(P：0．048)；3．低危组隐灶癌行单侧与双侧甲状腺切除，术后均无复发；4．颈淋巴结二a清扫与颈淋巴结切除比较，术后复发率和5年生存率无显著差异(P=0．202)。结论1．对低危组PTC患者宜行双侧甲状腺医切除，对乖于．隐灶癌，建议行患侧腺叶切除加峡部切除；2．低危组可不行预防性颈淋巴结清扫；3．高危组应行双侧甲状腺切除加颈淋巴结清扫大Ⅷ【关键词】甲状腺乳头状癌；甲状腺切除；颈淋巴结清扫学Me【中圈分类号】R736，1【文献标识码】A学a报uAnalysisofsurgerya

3、ndprognosisinpapillarythyroidcarcinomasSVWENGZI-yi，FEIZhe-wei，WUKe-jin，WUZeng-bin，LIFang-ming，QrANZhi-wei(DepartmentofGeneralSurgery，XinhuaHospital，ShanghaiSecondMedicalUniversity，Shanghai200092，China)Abstract：ObjectiveToassesstherelationshipbetweentheprognosisandthyroidectomyinsurgeryo

4、fpapillarythyroidcarcinoma(PTC)．MethodsWefollowedupthe124patientswithPTCaftersurgery．Comparetheopera—tions，recurrencesandsurvivalrateindifferentgroupsusingtheWilcoxon(Gehan)statisticandChi—Squaretest．Results1．Statisticalanalysisshowedthatsignificantdifferenceoflymph—nodemetastasisbetwee

5、nthelow—riskgroupandhigh—riskgroupofPTC(P=0．013)，thelymph—nodemetastasisrateofthelow-riskgroupissignificantlylowerthanthehigh—riskgroup．Likewise，thelymph—nodemetastasisrateofoccultthyroidcarcinoma(OTC)issignificantlylowerthanothers，thereissignificantdifference(P=0．008)；2．Comparingthe5-y

6、earnon—tumorsurvivalofPTC，therateofhigh—riskgroupissignificantlyhigherthanthelow—riskgroup(P：0．048)：3．Therearenorecurrencesofoccultthyroidcarcinomasinthelow—riskgroupafterunilateralthyroidectomy(UT)aswellasbilateralthyroidectomy(BT)；4．Comparingwithneckdissection(ND)andnode—picking(NP)，t

7、herecurrencerateand5-yearsurvivalratehavenosignificantdifference(P=0．202)．Conclusion1．Forlow—riskpapillarythyroidcarcinoma，bilateralthy—roidectomyisthetreatment．WesuggestunilaterallobectomyandisthmectomywouldtakeforOTC．2．Forlow—riskPTC，wewouldnotundertakepreventiveneckdissectio