本文關(guān)鍵詞： 甲狀腺偶發(fā)癌 背景因素 治療方式 淋巴結(jié)廓清　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析甲狀腺手術(shù)中偶發(fā)癌灶檢測(cè)出的比率以及甲狀腺偶發(fā)癌與甲狀腺背景因素之間的相關(guān)性,并探討此類病人行全甲狀腺切除術(shù)(TT)的條件,避免偶發(fā)癌灶的術(shù)中遺漏。方法:收集大連醫(yī)科大學(xué)附屬第一醫(yī)院普通外科于2014年06月—2016年12月確診為甲狀腺癌(Thyroid cancer,TC)并接受TT治療的病人404例,采用單因素分析的統(tǒng)計(jì)學(xué)方法進(jìn)行統(tǒng)計(jì)分析。用Excel表建立數(shù)據(jù)庫(kù),對(duì)性別、年齡、結(jié)節(jié)性甲狀腺腫、橋本氏病、基礎(chǔ)疾病單發(fā)還是多發(fā)、基礎(chǔ)腫瘤大小6個(gè)因素采用單因素分析,推斷甲狀腺偶發(fā)癌(incidental papillarycarcinoma,IPC)的發(fā)生與甲狀腺背景疾病的相關(guān)性。結(jié)果:本組共收集404例甲狀腺癌病人,其中44例術(shù)中或術(shù)后病理中檢測(cè)出術(shù)前未發(fā)現(xiàn)的癌灶,占本組比率為10.89%。14例男性,30例女性,男女比為1:2.14,年齡27歲-64歲,平均年齡47.5±10.79歲。偶發(fā)癌灶位于右葉甲狀腺的病人有21例(47.73%),偶發(fā)癌灶位于左葉甲狀腺的病人有20例(45.45%),偶發(fā)癌灶位于雙側(cè)甲狀腺的有3例(6.82%),因單側(cè)甲狀腺癌行甲狀腺全切術(shù)發(fā)現(xiàn)對(duì)側(cè)腺葉偶發(fā)癌灶的有34例(77.27%),因雙側(cè)甲狀腺癌行甲狀腺全切術(shù)發(fā)現(xiàn)大癌灶旁邊的偶發(fā)癌灶的有10例(22.73%)。未行中央?yún)^(qū)淋巴結(jié)廓清術(shù)10例,行中央?yún)^(qū)淋巴結(jié)廓清術(shù)34例。術(shù)后病理診斷:對(duì)所有病人的偶發(fā)癌灶進(jìn)行病理學(xué)檢查,結(jié)果均回報(bào)為微小乳頭狀癌,44例病人中TC合并結(jié)節(jié)性甲狀腺腫者35人(79.55%),TC合并橋本氏病(又稱慢性淋巴細(xì)胞性甲狀腺炎)者11人(25%),未合并甲狀腺良性疾病者1人(2.27%),合并結(jié)甲和橋本氏病者3人(6.82%)。對(duì)所有數(shù)據(jù)進(jìn)行單因素分析后結(jié)果顯示:合并結(jié)甲因素X2=3.858、P0.05;合并橋本氏病因素X2=6.477、P=0.01;合并兩種基礎(chǔ)病因素X2=89.41、P0.05;原發(fā)腫瘤直徑大小因素X2=7.729、P=0.005;提示我們病人是否合并結(jié)節(jié)性甲狀腺腫、橋本氏病、多發(fā)基礎(chǔ)病與原發(fā)腫瘤直徑等4個(gè)因素是導(dǎo)致IPC有相關(guān)關(guān)系的病因之一;性別、年齡2個(gè)因素與IPC無(wú)相關(guān)關(guān)系。結(jié)論:IPC是病灶微小,發(fā)病隱匿,預(yù)后較好的惡性腫瘤,常與結(jié)節(jié)性甲狀腺腫或橋本氏病等甲狀腺良性病變并存,術(shù)前臨床檢查不易被發(fā)現(xiàn),術(shù)前及術(shù)中的漏診或誤診率較高。本組病例的研究顯示TC病人合并結(jié)節(jié)性甲狀腺腫及原發(fā)腫瘤小于5毫米的IPC的出現(xiàn)率較高。TC病人行TT中IPC檢出比率約10.89%。經(jīng)過(guò)TT治療后的TC病人預(yù)后良好,可降低IPC其漏診率、術(shù)后復(fù)發(fā)率與轉(zhuǎn)移率。本組資料的統(tǒng)計(jì)學(xué)單因素分析顯示結(jié)節(jié)性甲狀腺腫、橋本氏病與原發(fā)腫瘤大小小于5mm是IPC的相關(guān)因素,在臨床上對(duì)于TC合并結(jié)節(jié)性甲狀腺腫、橋本氏病的病人,建議采取TT治療。
[Abstract]:Objective: to analyze the detection rate of incidental carcinomas in thyroid surgery and the correlation between incidental thyroid carcinomas and thyroid background factors, and to explore the conditions of total thyroidectomy (TTT) in these patients. Methods: a total of 404 patients who were diagnosed as thyroid cancer from June 2014 to December 2016 in general surgery of the first affiliated Hospital of Dalian Medical University and received TT treatment were collected. The Excel table was used to establish a database for sex, age, nodular goiter, Hashimoto's disease, primary disease or multiple diseases. By univariate analysis, we inferred the correlation between the incidence of incidental thyroid carcinoma and thyroid background diseases. Results: 404 patients with thyroid carcinoma were collected. Among them, 44 cases (10.89%) were diagnosed as preoperatively or pathologically undiscovered cancer foci, accounting for 10.89% (30 cases) of male and female, the ratio of male to female was 1: 2.14 (age 27 to 64 years), the ratio of male to female was 1: 2.14, the age was 27 to 64 years old. The mean age was 47.5 鹵10.79 years. There were 21 patients with incidental carcinomas located in the right lobe thyroid gland, 20 patients with incidental cancer foci located in Zuo Ye's thyroid gland, and 3 patients with incidental carcinomas located in the bilateral thyroid gland. 34 cases (77.27%) were found by total resection of the contralateral lobes of the gland, and 10 cases (22. 7335%) were found by total thyroidectomy of bilateral thyroid carcinoma, and 10 cases were not treated with central lymph node dissection. 34 cases of central lymph node dissection were performed. Results among 44 patients with small papillary carcinoma, there were 35 patients with TC complicated with nodular goiter, 11 with Hashimoto's disease (also called chronic lymphocytic thyroiditis) and 1 without benign thyroid disease. After univariate analysis of all the data, the results showed that the combined factor X _ 2o _ (3.858) (P _ (0.05)), combined with Hashimoto's disease (X _ 26.477) P _ (0.01), combined with two basic disease factors (X _ (289.41) P _ (0.05)), primary tumor diameter (X _ 2N _ (7.729)) P _ (0.005); Is our patient complicated with nodular goiter, Hashimoto's disease, multiple underlying diseases and primary tumor diameter were one of the causes of IPC, sex and age had no correlation with IPC. Malignant tumors with good prognosis often coexist with benign thyroid lesions such as nodular goiter or Hashimoto's disease. The rate of missed diagnosis or misdiagnosis was higher before and during operation. The study of this group of cases showed that the occurrence rate of IPC with nodular goiter and primary tumor less than 5 mm in TC patients was higher than that in patients with TC. The detection rate of IPC in TT was about 10.89% in patients with TC. The prognosis of TC patients after treatment was good. The single factor analysis of the data showed that nodular goiter, Hashimoto's disease and the size of primary tumor less than 5 mm were the related factors of IPC. TT therapy is recommended clinically for TC patients with nodular goiter and Hashimoto's disease.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R736.1

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