分化型甲状腺癌外科手术方式探讨

目的探讨不同条件下分化型甲状腺癌(DTC)手术方式的选择与预后的关系。方法收集DTC患者325例的临床资料,采用分层Cox回归分析的方法 ,回顾性分析其影响预后的因素。校正其他因素后,评价不同的手术方式与分化型甲状腺癌预后的关系。结果患者性别、年龄、复发与否、临床病理分期、肿瘤大小、手术治疗方式均为预后的影响因素(P0.05);Cox多因素分析表明,年龄、治疗方式和临床病理分期对其预后影响有统计学意义(P0.05)。对年龄分层分析表明,与甲状腺全切组比较,高龄组单侧腺叶或加峡部切除为最佳手术方式(OR=0.320),低龄组不同手术方式OR值差异无统计学意义。根据临床病理分期分层,Ⅰ期采用单侧腺叶切除预后较好(OR=0.228),高分化期患者甲状腺次全切预后较好(OR=0.561)。结论年龄、治疗方式和临床病理分期是影响分化型甲状腺癌预后的主要因素,针对患者不同年龄、临床病理分期及患者耐受情况,采取最优的手术方式。

Investigation of surgical operational mode for differentiated thyroid cancer

Objective To investigate the operational mode ofdifferentiated thyroid carcinoma（DTC）in different condition and its relationship with prognosis.Methods Retrospective analysis the clinical data of 325 cases of DTC treated from 1993 to 2000,and according the main factors influencing prognosis,we do stratified analysis using multivariate cox regression model by corrected confounded factors,to evaluate the relationship between surgical operational mode and prognosis of DTC.Results The factors that influenced the prognosis of DTC included gender,age,recurrence,clinicopathological stage,primary tumor size,and treatment pattern（P 0.05）,but only age,treatment pattern and clinicopathological stage influenced the prognosis of DTC according to Cox multivariate analysis（P0.05）.Stratified by age,hemithyroideetomys with isthmus resections was the best way in the higher age group,and taking total thyroidectomy as reference,it＇s OR was 0.320.But in the lower age group,there was no significant statistical difference in operational mode.Taking clinicopathological stage as a stratified factor,hemithyroideetomy was a good choice（OR=0.228）in stageⅠ,but in the higer stage,subtotal thy-roidectomy seemed better（OR=0.561）.Conclusions Age,operational mode and clinicopathological stage are main factors that influenced the prognosis of DTC.We should select the best surgical operational mode by take the patient＇s tolerance as consideration,according to age and clinicopathological stage.