专题研究(Monographic Study)

云南省单中心279例甲状腺乳头状癌再手术原因分析

Published at: 2017年第26卷第11期

刘文 1 , 程若川 1 , 张建明 1 , 钱军 1 , 马云海 1 , 刁畅 1 , 苏艳军 1 , 刘瑾 1
1 昆明医科大学第一附属医院 甲状腺疾病诊治中心,云南 昆明 650032
通讯作者 若川 程 Email: cruochuan@foxmail.com
DOI: 10.3978/j.issn.1005-6947.2017.11.003
基金:
云南省卫生内设研究机构基金资助项目 2017NS055

摘要

目的:探讨甲状腺乳头状癌(PTC)再手术患者复发原因及影响因素。方法:回顾性分析2007年1月—2016年6月间昆明医科大学第一附属医院甲状腺疾病诊治中心279例行再手术的PTC患者临床资料。结果:279例患者中,残余甲状腺复发156例(55.9%),淋巴结转移215例(77.1%),后者包括中央区135例(48.4%)和侧方151例(54.1%)。统计分析显示,女性、≥45岁是残余甲状腺复发的独立危险因素(均P<0.05);未行中央区淋巴结清扫(CND)、初次手术行于县级医院是中央区淋巴结转移的独立危险因素(均P<0.05);男性、初次术式为甲状腺全切或近全切(TT/NTT)、CND为侧方淋巴结转移的独立危险因素(均P<0.05)。初次手术后中位复发时间专业甲状腺中心为33个月,主要为侧方(26.8%)和中央区淋巴结转移(42.9%);省级医院为24个月,主要为中央区区淋巴结转移(32.8%)和残余甲状腺复发(29.9%);地州级24个月、县级12个月,主要原因为残余甲状腺复发(36.7%,45.9%)。再次手术后,158例获随访10~123个月,死亡1例(0.4%)、永久性声音嘶哑7例(4.4%)、永久性低钙血症19例(12.0%)、131I治疗失分化9例(5.7%),复发22例(13.9%)。结论:非专科手术和不规范的术式导致PTC术后甲状腺和淋巴结转移率增高从而再手术的主要原因;选择单侧腺叶切除或TT/NTT+病灶同侧/双侧CND和/或加行侧方淋巴结清扫可有效降低复发率。再次手术患者永久性手术并发症和失分化发生率均较高,故应在初始治疗中采取规范化治疗方案,减少复发风险。


Causes for reoperation of papillary thyroid carcinoma: analysis of 279 cases in a single-center of Yunnan province

Abstract

Objective: To investigate reasons for reoperation of papillary thyroid carcinoma (PTC) patients and the influential factors. Methods: The clinical data of 279 PTC patients undergoing reoperation from January 2007 to June 2016 were retrospectively analyzed. Results: Of the 297 patients, thyroid remnant cancer recurrence occurred in 156 cases (55.9%) and lymph node metastases occurred in 215 cases (77.1%), and the latter included central lymph node metastasis in 135 cases (48.4%) and lateral lymph node metastasis in 151 cases (54.1%). Statistical analyses showed that female gender and age≥45 years were independent risk factors for thyroid remnant cancer recurrence (both P<0.05); no central lymph node dissection (CND) and initial operation performed at a county-level hospital were independent risk factors for central lymph node metastasis (both P<0.05); male gender and total/near total thyroidectomy (TT/NTT) and CDN used as an initial procedure were independent risk factors for lateral lymph node metastasis (all P<0.05). The median recurrence time from the first operation was 33 months for patients undergoing the first operation at a hospital specialized in thyroid treatments, and they mainly had lateral lymph node metastasis (26.8%) and central lymph node metastasis (42.9%); it was 24 months in a province-level hospital, and they mainly had central lymph node metastasis (32.8%) and thyroid remnant cancer recurrence (29.9%); it was 24 and 12 months in a district- or prefecture-level and county-level hospital, and they mainly had thyroid remnant cancer recurrence of 36.7% and 45.9%, respectively. After reoperation, follow-up was obtained in 158 patients for 10 to 123 month, and of them, one case (0.4%) died, permanent hoarseness occurred in 7 cases (4.4%), permanent hypocalcemia occurred in 19 cases (12.0%), dedifferentiation after 131I therapy occurred in 9 cases (5.7%) and recurrence occurred in 22 cases (13.9%). Conclusion: Non-specialized operation and improper procedure are main reasons for increased postoperative thyroid remnant cancer recurrence and lymph node metastases and thereby reoperation in PTC. Lobectomy or TT/NTT plus ipsilateral or bilateral CND and/or combined with LND may effectively reduce the recurrence rates. The incidences of permanent surgical complications and dedifferentiation are higher after reoperation, so appropriate treatment should be taken in the initial treatment to reduce the risk of recurrence.


comments powered by Disqus

全文

引用

引用本文: 文 刘, 若川 程, 建明 张, 军 钱, 云海 马, 畅 刁, 艳军 苏, 瑾 刘. 云南省单中心279例甲状腺乳头状癌再手术原因分析[J]. 中国普通外科杂志, 2017, 26(11): 1383-1391.
Cite this article as: LIU Wen, CHENG Ruochuan, ZHANG Jianming, QIAN Jun, MA Yunhai, DIAO Chang, SU Yanjun, LIU Jin . Causes for reoperation of papillary thyroid carcinoma: analysis of 279 cases in a single-center of Yunnan province[J]. Chin J Gen Surg, 2017, 26(11): 1383-1391.