摘要
目的分析预防性颈中央区淋巴结清扫在甲状腺乳头状癌治疗中的作用。方法选择上海交通大学医学院附属瑞金医院卢湾分院2019年7月—2021年12月收治的593例甲状腺乳头状癌患者为研究对象,通过随机摸红蓝球方式将所有患者分为常规组(296例,手术期间不对颈中央区淋巴结进行特殊处理)以及研究组(297例,进行预防性颈中央区淋巴结清扫),对比两组患者术后复发率以及病灶远期转移率,手术并发症发生率,手术前以及手术后3 d甲状旁腺激素、血钙水平,手术前以及手术后1个月甲状腺球蛋白抗体、甲状腺球蛋白水平。结果研究组与常规组患者术后复发率(3.03%vs 10.14%),病灶远期转移率(1.01%vs11.82%)比较,差异有统计学意义(χ^(2)=12.180、28.908,P<0.05);两组手术后3 d甲状旁腺激素以及血钙水平均低于手术前,差异有统计学意义(P<0.05);手术后1个月研究组患者甲状腺球蛋白抗体、甲状腺球蛋白水平低于常规组,且两组手术1个月后甲状腺球蛋白抗体、甲状腺球蛋白水平均低于手术前,差异有统计学意义(P<0.05)。结论将预防性颈中央区淋巴结清扫应用于甲状腺乳头状癌治疗中,能够降低疾病复发率以及病灶远期转移率,不会增加并发症,并且不会对甲状腺功能造成较大损伤,可发挥一定干预作用。
Objective To analyze the role of prophylactic cervical central zone lymph node dissection in the treatment of papillary thyroid cancer.Methods 593 cases of papillary thyroid cancer admitted to Luwan Branch of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine from July 2019 to December 2021 were selected as the research object.All patients were assigned to the conventional group(296 patients,without special treatment of the central cervical lymph nodes during surgery)and the study group(297 patients,with prophylactic lymph node dissection in the central cervical area)by randomized touching of red and blue balls.The postoperative recurrence rate and the rate of distant metastases between the two groups,the rate of surgical complications,the levels of parathyroid hormone and blood calcium before and 3 days after surgery,and the levels of thyroglobulin antibody and thyroglobulin before and one month after surgery between the two groups.Results Compared the postoperative recurrence rates(3.03%vs 10.14%)and the distant metastasis rates(1.01%vs 11.82%)between the study group and conventional group,the difference was statistically significant(χ^(2)=12.180,28.908,P<0.05);parathyroid hormone and blood calcium levels in the two group 3 days after surgery were lower than those before surgery,the difference was statistically significant(P<0.05);the levels of thyroglobulin antibodies and thyroglobulin in the study group one month surgery were lower than those in the conventional group after surgery,and the levels of thyroglobulin antibodies and thyroglobulin in the two groups one month after surgery were lower than those before surgery,the difference was statistically significant(P<0.05).Conclusion The application of prophylactic lymph node dissection in the central cervical region in the treatment of papillary thyroid cancer can reduce the recurrence rate and the distant metastasis rate of the lesions increasing the complictions and without causing greater damage to thyroid function,and can play a certain interventional role.
作者
沈依
李小恩
陈彧泮
谢荣理
SHEN Yi;LI Xiao'en;CHEN Yupan;XIE Rongli(Department of General Surgery,Luwan Branch of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,Shanghai,200020 China)
出处
《系统医学》
2022年第22期144-147,160,共5页
Systems Medicine
基金
上海市黄浦区卫健委面上项目(HKM201907)。
关键词
复发率
颈中央区淋巴结清扫
甲状腺乳头状瘤
甲状腺功能
并发症
Recurrence rate
Lymph node dissection in the central cervical region
Papillary thyroid cancer
Thyroid function
Complications
