单侧甲状腺微小乳头状癌对侧腺体隐匿癌灶的预测因素及手术治疗策略
发布时间：2018-08-30 08:40
【摘要】：目的既往对单侧甲状腺微小乳头状癌(PTMC)的术式仍存在分歧,文中旨在探讨单侧甲状腺微小乳头状癌对侧腺体隐匿癌灶的预测因素,分析比较单侧PTMC的手术方式。方法回顾性分析哈尔滨医科大学附属第一医院乳腺外科2014年01月至2016年01月经术前彩超检查局限于单侧腺体的PTMC患者327例,根据对侧腺体是否存在隐匿癌灶分为单侧腺体癌灶者(n=278)与双侧腺体癌灶者(n=49);根据是否行预防性中央区淋巴结清扫分为淋巴结清扫者(n=117)与淋巴结未清扫者(n=210),进一步分析对侧腺体隐匿癌灶的预测因素及中央区淋巴结预防性清扫术后相关并发症。结果预防性行中央区淋巴结清扫术患者117例中存在中央区淋巴结转移者55例,转移率为47.0%。患侧腺体内多发癌灶是对侧腺体内存在隐匿癌灶的危险因素(OR=4.924,95%CI:1.605~15.107)。淋巴结清扫者和淋巴结未清扫者术后并发症差异无统计学意义(P0.05)。结论单侧腺体内PTMC多发癌灶可以帮助预测对侧腺体隐匿癌灶的存在,并且中央区淋巴结转移率较高,建议对于单侧腺体内多发癌灶的PTMC行甲状腺全切除术+中央区淋巴结预防性清扫术。
[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.
【作者单位】： 哈尔滨医科大学附属第一医院乳腺外科;
【分类号】：R736.1
[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.
【作者单位】： 哈尔滨医科大学附属第一医院乳腺外科;
【分类号】：R736.1
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