甲状腺系膜切除术对甲状腺乳头状癌病人复发转移率影响

目的 探讨甲状腺系膜切除术在甲状腺乳头状癌病人中央区淋巴结清扫中的效果及其对远期预后的影响。 方法 选择行甲状腺癌根治术的140例甲状腺乳头状癌病人，其中行甲状腺系膜切除术病人50例作为观察组，行常规中央区淋巴结清扫病人90例作为对照组。比较2组病人手术指标、术后并发症发生率以及手术后血清甲状旁腺激素（PTH）、血钙水平。随访至2019年1月，随访终点为复发或转移，比较2组病人复发转移率。 结果 观察组手术时间明显长于对照组（P < 0.01），2组术中出血量、术后住院时间及术后下床活动时间差异均无统计学意义（P>0.05）。2组病人手术前后的血清PTH、血钙水平差异均无统计学意义（P>0.05）。2组病人术后并发症差异无统计学意义（P>0.05）。观察组无二次手术病人，对照组中1例进行二次手术，2组二次手术率差异无统计学意义（P>0.05）。随访24~60个月，观察组复发转移率低于对照组（P < 0.05）。多因素分析显示，TNM分期、腺外侵犯、淋巴结转移、甲状腺系膜切除均为甲状腺乳头状癌病人复发转移率的独立影响因素（P < 0.05）。 结论 甲状腺系膜切除术的短期效果与常规中央区淋巴结清扫相当，远期复发转移率较低，远期预后更佳。

Effect of thyroid mesangectomy on the recurrence and metastasis rates of thyroid papillary carcinoma patients

Objective To investigate the effects of thyroid mesangectomy on lymph node dissection in central region of thyroid papillary carcinoma patients, and its influence on long-term prognosis. Methods One hundred and forty thyroid papillary carcinoma patients treated with radical thyroidectomy were divided into the observation group (50 cases treatment with thyroid mesangectomy) and control group (90 cases treatment with conventional central lymph node dissection).The surgical indexes, postoperative complications, and serum levels of postoperative parathyroid hormone (PTH) and calcium were compared between two groups.The patients were followed up to January 2019, and the recurrence and metastasis rate was compared between two groups. Results The operation time in observation group was significantly longer than that in control group (P < 0.01).There was no statistical significance in the amount of intraoperative blood loss, postoperative hospital stay and postoperative ambulation time between two groups (P>0.05).There was no statistical significance in the serum levels of PTH and calcium between two groups before and after operation, and the difference of postoperative complications was not statistically significant (P>0.05).No patients in the observation group received secondary surgery, while 1 patient in the control group received secondary surgery, and the difference of which was not statistically significant (P>0.05).During the following up of 24 to 60 months, the recurrence and metastasis rate in observation group was lower than that in control group (P < 0.05).The results of multivariate analysis showed that the TNM staging, extraglandular invasion, lymph node metastasis and thyroid mesangial resection were the independent factors influencing the recurrence and metastasis rate of thyroid papillary carcinomas (P < 0.05). Conclusion The short-term efficacy of thyroid mesangectomy is comparable to that of conventional central lymph node dissection.The long-term recurrence and metastasis rate is lower, and the long-term prognosis is better.