發(fā)布時間：2018-08-30 08:40

【摘要】：目的既往對單側(cè)甲狀腺微小乳頭狀癌(PTMC)的術(shù)式仍存在分歧,文中旨在探討單側(cè)甲狀腺微小乳頭狀癌對側(cè)腺體隱匿癌灶的預(yù)測因素,分析比較單側(cè)PTMC的手術(shù)方式。方法回顧性分析哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院乳腺外科2014年01月至2016年01月經(jīng)術(shù)前彩超檢查局限于單側(cè)腺體的PTMC患者327例,根據(jù)對側(cè)腺體是否存在隱匿癌灶分為單側(cè)腺體癌灶者(n=278)與雙側(cè)腺體癌灶者(n=49);根據(jù)是否行預(yù)防性中央?yún)^(qū)淋巴結(jié)清掃分為淋巴結(jié)清掃者(n=117)與淋巴結(jié)未清掃者(n=210),進(jìn)一步分析對側(cè)腺體隱匿癌灶的預(yù)測因素及中央?yún)^(qū)淋巴結(jié)預(yù)防性清掃術(shù)后相關(guān)并發(fā)癥。結(jié)果預(yù)防性行中央?yún)^(qū)淋巴結(jié)清掃術(shù)患者117例中存在中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移者55例,轉(zhuǎn)移率為47.0%�；紓�(cè)腺體內(nèi)多發(fā)癌灶是對側(cè)腺體內(nèi)存在隱匿癌灶的危險因素(OR=4.924,95%CI:1.605~15.107)。淋巴結(jié)清掃者和淋巴結(jié)未清掃者術(shù)后并發(fā)癥差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論單側(cè)腺體內(nèi)PTMC多發(fā)癌灶可以幫助預(yù)測對側(cè)腺體隱匿癌灶的存在,并且中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移率較高,建議對于單側(cè)腺體內(nèi)多發(fā)癌灶的PTMC行甲狀腺全切除術(shù)+中央?yún)^(qū)淋巴結(jié)預(yù)防性清掃術(shù)。
[Abstract]:Objective to investigate the prognostic factors of unilateral thyroid micropapillary carcinoma (PTMC) and to analyze and compare the surgical methods of unilateral PTMC. Methods A retrospective analysis was made on 327 patients with PTMC whose preoperative color ultrasound examination was confined to unilateral glands from January 2014 to January 2016 in mammary surgery, the first affiliated Hospital of Harbin Medical University. According to whether the contralateral gland has occult cancer foci, it can be divided into unilateral adenoma foci (NN278) and bilateral glandular carcinomas (nnm49), and according to whether preventive central area lymph node dissection is performed, lymph node dissection (nm117) and undissected lymph nodes (nm210) are further studied. To analyze the prognostic factors of contralateral gland occult carcinoma and the complications after central lymph node dissection. Results among the 117 patients with central lymph node dissection, 55 cases had central lymph node metastasis, and the metastasis rate was 47.0%. Multiple cancerous foci in the affected side of the gland are the risk factors for concealed cancer in the contralateral gland (OR=4.924,95%CI:1.605~15.107). There was no significant difference in postoperative complications between lymph node dissection and undissected lymph node (P0.05). Conclusion multiple PTMC foci in unilateral glands can help predict the presence of occult contralateral adenomas, and the lymph node metastasis rate in the central region is higher. It is recommended that PTMC with multiple intraglandular lesions be treated with total thyroidectomy and central lymph node dissection.
【作者單位】： 哈爾濱醫(yī)科大學(xué)附屬第一醫(yī)院乳腺外科;
【分類號】：R736.1

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