甲状腺癌外科治疗及预后因素的研究

目的探讨甲状腺癌的临床病理特点、诊断和治疗,为进一步提高临床治疗效果提供新的资料和思路。方法回顾性分析1998年1月-2008年12月本医院外科手术治疗并病理确诊的344例甲状腺癌的临床资料,随访11个月～12年,所得数据使用SPSS13.0统计软件包进行分析,P〈0.05为差异具有统计学意义。结果本组资料统计结果显示344名患者中,男女发病比为1：2.8,存在明显差异。平均发病年龄为39.4岁,发病高峰年龄段在21～40岁之间。肿瘤组织分类中,以分化型甲状腺癌为主,占89.0%,其中乳头状癌占82.0%。甲状腺全切除组与甲状腺非全切除组相比,手术并发症较高,差异有显著性（P〈0.05）,而术后复发、颈淋巴结转移差异无显著性（P〉0.05）。甲状腺癌再次手术与初次手术相比,术后并发症、复发以及颈淋巴结转移均差异无显著性。结论手术切除是甲状腺癌的主要治疗方法,手术方式应根据病变性质、TNM分期及病人情况而采取个体化方案;影响甲状腺癌预后的因素有：性别、年龄、肿瘤大小、侵犯甲状腺外膜、临床病理分期。

Study on the surgical treatment and prognostic factors for thyroidcarcinoma

Objective To study the clinical patho-feature,diagnosis and treatment of thyroid carcinoma,and provide references for improving the prognosis of thyroid carcinoma.Metbods The clinical and clinicopathologic data of 344 patients with thyroid carcinoma treated at our hospital from January 1998 to December 2008 were analyzed retrospectively.The diagnosis of all patients was confirmed with surgery and pathlogy.They were followed up for period ranging between the time from 11 months to 12 years.Kaplan-Meier method,Log-lang test were used to analyze the prognostic variables of thyroid carcinoma by SPSS 13.0 soft wares,P<0.05 was considered statistically significant.Results The ratio for man to women was 1:2.8,there was a significant difference for gender.The peak age of thyroid malignant carcinoma was between 21～40 years old,the average age was 39.4 years old.The main pathological type was differentiation thyroid carcinoma,it was account for 89.0%.The papillary carcinoma was about 82.0% in differentiation thyroid carcinoma.The incidence of the postoperative complications in the total thyroidctomy group was higher than that in the other thyroidectomy group(P<0.05),There were not any significant difference of the rate of the local recurrence and metastasis between two groups(P>0.05).Gender,age,tumor size,infiltration,clinicopathological stage were main factors that influenced the prognosis of thyroid carcinoma.Conclusions The operation was the main treatment.The operation modes should be individualized according to TNM stages,location,size and the situation of lymph metastasis.Gender,age,tumor size,infiltration,clinicopathological stage were the main factors that influenced the prognosis of thyroid carcinoma.