甲状腺偶发癌灶背景因素及治疗方式探讨

发布时间：2018-02-21 22:55

本文关键词： 甲状腺偶发癌背景因素治疗方式淋巴结廓清　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析甲状腺手术中偶发癌灶检测出的比率以及甲状腺偶发癌与甲状腺背景因素之间的相关性,并探讨此类病人行全甲状腺切除术(TT)的条件,避免偶发癌灶的术中遗漏。方法:收集大连医科大学附属第一医院普通外科于2014年06月—2016年12月确诊为甲状腺癌(Thyroid cancer,TC)并接受TT治疗的病人404例,采用单因素分析的统计学方法进行统计分析。用Excel表建立数据库,对性别、年龄、结节性甲状腺肿、桥本氏病、基础疾病单发还是多发、基础肿瘤大小6个因素采用单因素分析,推断甲状腺偶发癌(incidental papillarycarcinoma,IPC)的发生与甲状腺背景疾病的相关性。结果:本组共收集404例甲状腺癌病人,其中44例术中或术后病理中检测出术前未发现的癌灶,占本组比率为10.89%。14例男性,30例女性,男女比为1:2.14,年龄27岁-64岁,平均年龄47.5±10.79岁。偶发癌灶位于右叶甲状腺的病人有21例(47.73%),偶发癌灶位于左叶甲状腺的病人有20例(45.45%),偶发癌灶位于双侧甲状腺的有3例(6.82%),因单侧甲状腺癌行甲状腺全切术发现对侧腺叶偶发癌灶的有34例(77.27%),因双侧甲状腺癌行甲状腺全切术发现大癌灶旁边的偶发癌灶的有10例(22.73%)。未行中央区淋巴结廓清术10例,行中央区淋巴结廓清术34例。术后病理诊断:对所有病人的偶发癌灶进行病理学检查,结果均回报为微小乳头状癌,44例病人中TC合并结节性甲状腺肿者35人(79.55%),TC合并桥本氏病(又称慢性淋巴细胞性甲状腺炎)者11人(25%),未合并甲状腺良性疾病者1人(2.27%),合并结甲和桥本氏病者3人(6.82%)。对所有数据进行单因素分析后结果显示:合并结甲因素X2=3.858、P0.05;合并桥本氏病因素X2=6.477、P=0.01;合并两种基础病因素X2=89.41、P0.05;原发肿瘤直径大小因素X2=7.729、P=0.005;提示我们病人是否合并结节性甲状腺肿、桥本氏病、多发基础病与原发肿瘤直径等4个因素是导致IPC有相关关系的病因之一;性别、年龄2个因素与IPC无相关关系。结论:IPC是病灶微小,发病隐匿,预后较好的恶性肿瘤,常与结节性甲状腺肿或桥本氏病等甲状腺良性病变并存,术前临床检查不易被发现,术前及术中的漏诊或误诊率较高。本组病例的研究显示TC病人合并结节性甲状腺肿及原发肿瘤小于5毫米的IPC的出现率较高。TC病人行TT中IPC检出比率约10.89%。经过TT治疗后的TC病人预后良好,可降低IPC其漏诊率、术后复发率与转移率。本组资料的统计学单因素分析显示结节性甲状腺肿、桥本氏病与原发肿瘤大小小于5mm是IPC的相关因素,在临床上对于TC合并结节性甲状腺肿、桥本氏病的病人,建议采取TT治疗。
[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 卤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.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

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