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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 447 -449. doi: 10.3877/cma.j.issn.1674-3946.2021.04.026

论著

两种手术方式治疗甲状腺微小乳头状癌的安全性及近期预后比较
文骝1,†(), 庞士勇1, 李娟1   
  1. 1. 237000　安徽医科大学附属六安医院
  • 收稿日期:2020-09-19 出版日期:2021-08-17
  • 通信作者: 文骝

Comparison of safety and short-term clinical outcome of two surgical procedures in treating papillary thyroid microcarcinoma

Liu Wen1,†(), Shiyong Pang1, Juan Li1   

  1. 1. Liu’an Hospital Affiliated to Anhui Medical University, Anhui 237000, China
  • Received:2020-09-19 Published:2021-08-17
  • Corresponding author: Liu Wen
  • Supported by:
    Scientific Research Project of Anhui Health Planning Commission(2016QK028)
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文骝, 庞士勇, 李娟. 两种手术方式治疗甲状腺微小乳头状癌的安全性及近期预后比较[J]. 中华普外科手术学杂志(电子版), 2021, 15(04): 447-449.

Liu Wen, Shiyong Pang, Juan Li. Comparison of safety and short-term clinical outcome of two surgical procedures in treating papillary thyroid microcarcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(04): 447-449.

目的

探讨患侧甲状腺联合峡部切除术合并中央区淋巴结清扫术治疗甲状腺微小乳头状癌(PTMC)的安全性和近期预后比较。

方法

回顾性分析2017年1月至2020年6月90例PTMC患者资料，根据是否进行中央区淋巴结清扫术分为两组，其中40例予以患侧甲状腺联合峡部切除术联合中央区淋巴结清扫术(清扫组)，50例予以患侧甲状腺联合峡部切除术(未清扫组)。统计学分析采用SPSS 23.0软件进行比较，两组患者术中术后指标、甲状旁腺素(PTH)和血钙水平等计量资料采用(±s)表示，独立样本t检验。两组患者术后并发症发生率、复发率和转移率采用χ2检验，P<0.05为差异有统计学意义。

结果

未清扫组患者手术时间、术中出血量、切口长度、术后疼痛评分、引流管引流量、住院时间及术后并发症发生率均明显小于清扫组患者(P<0.05)，未清扫组术后血清PTH和血钙水平均明显高于清扫组患者(P<0.05)；两组术后2年复发率、转移率相比，差异无统计学意义(P>0.05)。

结论

患侧甲状腺联合峡部切除术治疗PTMC具有更好的治疗安全性和较低的并发症发生率，且不影响术后近期预后。

关键词: 甲状腺肿瘤, 癌, 乳头状, 甲状腺切除术, 淋巴结切除术, 安全, 疗效比较研究
Objective

To investigate the safety and short-term clinical outcome of combined isthmic thyroidectomy with central lymph node dissection in the treatment of papillary thyroid microcarcinoma(PTMC).

Methods

A retrospective analysis of the data of 90 patients with PTMC from January 2017 to June 2020 was divided into two groups according to whether the central lymph node dissection was performed, and 40 cases underwent the ipsilateral and isthmic thyroid resection combined with the central lymph node dissection(swept group), 50 cases underwent the ipsilateral and isthmic thyroid resection without the central area lymph node dissection (unswept group). Statistical analysis were performed by using SPSS 23.0 software. Measurement data such as Intraoperative and postoperative indicators, parathyroid hormone (PTH) and serum calcium level were expressed as (±s), and were examined by using independent t test. The incidence of postoperative complications, recurrence rate and metastasis rate of the two groups were analyzed by using χ2 test, and A P value of<0.05 was considered as statistically significant difference.

Results

The operative time, intraoperative bleeding, incision length, postoperative pain score, drainage volume, hospitalization time and postoperative complication rate in the unswept group were significantly lower than those in the swept group (P<0.05) , the levels of serum PTH and serum calcium were significantly higher in the unswept group than those in the swept group (P<0.05) , with no significant difference of the recurrence and metastasis rate between two groups (P>0.05).

Conclusion

Compared with the combined central lymph node dissection, the combined isthmic thyroidectomy without central lymph node dissection in the treatment of papillary thyroid carcinoma has advantages such as more safe and lower incidence of complications, with similar short-term clinical outcome.

Key words: Thyroid neoplasms, Carcinoma, papillary, Thyroidectomy, Lymph node excision, Safety, Comparative effectiveness research
表1 90例PTMC不同术式两组患者一般临床资料比较[(±s)，例]
组别 例 年龄(岁) 性别 BMI (kg/m2) 病变 结节直径(mm)
男/女 左/右
清扫组 40 47.3±10.2 13/27 22.5±5.2 18/22 5.3±1.2
未清扫组 50 46.9±9.8 18/32 22.3±5.3 23/27 5.4±1.3
t/χ2/F值   0.318 0.120 0.758 0.008 -0.178
P值   0.564 0.533 0.609 0.967 0.729
表2 90例PTMC不同术式两组患者手术相关指标比较(±s)
组别 例 手术时间(min) 术中出血量(ml) 切口长度(ml)
清扫组 40 116.5±21.3 47.3±8.1 8.5±0.6
未清扫组 50 71.7±13.6 28.3±5.1 6.3±0.5
t值   26.617 15.278 13.277
P值   0.013 0.035 0.038
表3 90例PTMC不同术式两组患者术后相关指标比较(±s)
组别 例 疼痛评分 引流量(ml) 住院时间(d)
清扫组 40 5.9±0.9 71.8±8.6 6.7±0.8
未清扫组 50 4.3±0.7 50.8±5.7 5.3±0.7
t值   13.563 18.212 12.178
P值   0.036 0.029 0.041
表4 90例PTMC不同术式两组患者术后PTH和血钙指标比较(±s)
组别 例 PTH(pg/ml) Ca2+(mmol/L)
术前 术后 术前 术后
清扫组 40 40.3±3.5 27.5±2.3 2.4±0.4 1.7±0.3
未清扫组 50 40.2±3.6 36.5±2.5 2.3±0.4 2.1±0.4
t值   0.623 -13.251 0.613 -15.299
P值   0.373 0.028 0.389 0.021
表5 90例PTMC不同术式两组患者术后1周不良反应事件比较[例(%)]
组别 例 切口感染 术后出血 甲状腺功能减退 甲状旁腺损伤 喉返神经损伤 合计
清扫组 40 4(10.0) 5(12.5) 4(10.0) 2(5.0) 4(10.0) 19(45.0)
未清扫组 50 1(2.0) 2(4.0) 1(2.0) 0 1(2.0) 5(10.0)
χ2值   2.710 2.238 2.710 3.879 2.710 19.531
P值   0.043 0.048 0.043 0.036 0.043 <0.001
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