云南省单中心 279 例甲状腺乳头状癌再手术原因分析
| 作者: |
1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 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: |
程若川
Email: cruochuan@foxmail.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2017.11.003 |
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。
关键词：
甲状腺肿瘤
癌，乳头状
再手术
因素分析，统计学
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
CorrespondingAuthor:Cheng Ruochuan Email: cruochuan@foxmail.com
Abstract
Objective: To investigate reasons for reoperation of papillary thyroid carcinoma (PTC) patients and the in uential factors.
Methods: e 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 ( / NTT) and CDN used as an initial procedure were independent risk factors for lateral lymph node metastasis (all P<0.05). e median recurrence time from the rst operation was 33 months for patients undergoing the rst 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. A er 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%), dedi erentiation a er 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. e incidences of permanent surgical complications and dedi erentiation are higher a er reoperation, so appropriate treatment should be taken in the initial treatment to reduce the risk of recurrence.
Keywords：
Thyroid Neoplasms
Carcinoma
Papillary
reoperation
Factor Analysis
Statistical
Methods: e 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 ( / NTT) and CDN used as an initial procedure were independent risk factors for lateral lymph node metastasis (all P<0.05). e median recurrence time from the rst operation was 33 months for patients undergoing the rst 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. A er 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%), dedi erentiation a er 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. e incidences of permanent surgical complications and dedi erentiation are higher a er reoperation, so appropriate treatment should be taken in the initial treatment to reduce the risk of recurrence.