甲状腺乳头状癌区域淋巴结清扫与131I治疗的对比分析

目的:比较甲状腺乳头状癌中央组淋巴结清扫与131Ⅰ辅助治疗的临床效果.方法:选择5年半内收治的390例甲状腺乳头状癌cN0患者的临床资料行回顾性分析,患者分别行甲状腺全切除+中央组淋巴结清扫(A组),甲状腺全切除+术后131Ⅰ治疗(B组)和单纯甲状腺全切除术(C组).结果:中央组淋巴结清扫组(A组)与非清扫组(B+C组)各种术后并发症(喉返神经损伤、喉上神经损伤、甲状旁腺功能低下)发生率差异无统计学意义(均P＞0.05)；B组131I治疗后放射病发生率为51.5％.3组术后5年复发率与转移率比较,A组中央区复发率分别为0,明显低于B组(7.7％)和C组(13.8％)(均P＜0.05)；A,B,C组颈侧区转移率及无影像学证据血清甲状腺球蛋白升高率依次增高(1.5％,6.2％,9.2％；3.1％,7.7％,15.4％),其中A组与C组间差异有统计学意义(均P＜0.05).B组平均住院日最长,住院费用最高,与A,C组比较,差异均有统计学意义(均P＜0.05).结论:甲状腺乳头状癌患者常规行中央组淋巴清扫有助于降低复发率,且无增加手术并发症风险；131I治疗不能完全代替淋巴结清扫术,且患者并发症、住院日和费用增加.

Comparative analysis of regional lymph node dissection and 131I therapy for papillary thyroid carcinoma

Objective: To compare the clinical efficacies between central compartment dissection and 131I ablation for papillary thyroid cancer (PTC) following total thyroidectomy.Methods: Three hundred and ninety patients with cN0 PTC treated within five and a half years in our hospital were selected and their clinical data were retrospectively analyzed. Patients underwent either total thyroidectomy plus central compartment dissection (group A) or total thyroidectomy plus 131I ablation (group B) or total thyroidectomy only (group C). Results: The differences in incidences of postoperative complications that included recurrent laryngeal nerve injury, superior laryngeal nerve injury and hypoparathyroidism between group of patients with central compartment dissection (group A) and group of patients without central compartment dissection (group B and C) showed no statistical significance (all P>0.05), and radiation injury associated with 131I therapy in group B was 51.5%. Comparisons in 5-year recurrence and metastasis among the three groups showed that the central compartment recurrence in group A was 0, which was significantly lower than that in group B (7.7%) or group C (13.8%) (both P<0.05). The incidences of lateral neck metastases and elevated serum thyroglobulin with no radiographic evidence presented an increase in ascending order in group A, B and C (1.5%, 6.2% and 9.2%; 3.1%, 7.7% and 15.4%, respectively), and the differences between group A and C had statistical significance (both P<0.05). The average length of hospital stay was longest with the highest hospitalization costs for group B, and the differences had statistical significance versus group A or group C (all P<0.05).Conclusion: Total thyroidectomy with central lymph node dissection for papillary thyroid cancer reduces the recurrence rate without an increased risk of complications. 131I treatment cannot completely replace lymph node dissection, and may also increase the associated complications, length of hospital stay and expenses of the patients.