cN1期甲状腺乳头状癌选择性淋巴结清扫术的手术效果分析

目的探讨对伴有淋巴结转移的c N1期甲状腺乳头状癌患者采用选择性保留颈部淋巴结清扫术的手术方法及其临床意义。方法选取2011年1月至2013年6月外科手术治疗的77例c N1期甲状腺乳头状癌患者进行研究,其中39例患者采用选择性保留颈部淋巴结清扫术治疗(保留组),38例患者采用常规的颈部淋巴结清扫术(常规组),数据分析采用SAS10.0软件,手术时间、手术出血量用均数±标准差(x珋±s)进行统计描述,组间比较采用t检验;感觉功能优良率、手术并发症率采用百分率(%)表示,组间比较采用χ~2检验;P值0.05表示差异具有统计学意义。结果保留组的手术时间长于常规组,差异具有统计学意义(P0.05),两组的术中出血量、术后3年复发率差异均无统计学意义(P0.05);术后3个月,保留组的术耳廓区、颈肩区的皮肤感觉功能优良率分别为89.74%、87.17%均高于常规组的71.05%和68.42%,差异具有统计学意义(P0.05);保留组的手术并发症率10.26%低于常规组的28.95%,差异具有统计学意义(P0.05)。结论 c N1期甲状腺乳头状癌患者采用选择性保留颈部淋巴结清扫术会延长手术时间,但是可显著的改善患者术后术区皮肤感觉功能、减少手术并发症。

Clinical analysis of selective neck dissection for patients with cN1 staging papillary thyroid carcinoma

Objective To investigate the clinical outcome of selective neck dissection in treating patients with cN1 staging papillary thyroid carcinoma.Methods From January 2011 to June 2013,77patients with cN1 staging papillary thyroid carcinoma received surgical treatment,including 39 patients with selective retention of cervical lymph node dissection (retention group) and 38 patients with routine cervical lymph node dissection (conventional group).Statistical analysis were performed by using SAS10.0 software.The measurement data were expressed as mean ± standard deviation (x ± s),and were examined by using t test,including operation time,blood loss and so on.Count data such as complication incidence (％) and sensory function preservation rate (％) were examined by using x2 test.A P value ＜ 0.05 was considered as statistically significant difference.Results The operation time in retention group was longer than that in outine group,with significant difference (P ＜ 0.05).There was no significant difference between two groups in terms of blood loss and 3 years survival (P ＞ 0.05).3 months post operation,sensory function preservation rate of neck and shoulder area and auricular region in retention group is 89.74％ and 87.17％,which were higher than 71.05％ and 68.42％ in routine group respectively,wiht significant difference (P ＜0.05).In retention group,complication rate of 10.26％ was lower than 28.95％ in routine group,with significant difference (P ＜ 0.05).Conclusion Selective retention of cervical lymph node dissection might prolong operation time,however it could significantly improve the postoperative sensory function and reduce postoperative complications of patients with stage cN1 thyroid papillary carcinoma.