局部晚期分化型甲状腺癌临床特点和疗效分析

目的探讨局部晚期分化型甲状腺癌的临床特点及治疗方法，以期提高患者的生存时间及生存质量。方法回顾性分析南昌大学第二附属医院1996年1月至2005年12月治疗的23例局部晚期分化型甲状腺癌的临床病理资料，包括年龄、病理类型、肿瘤局部侵犯情况、手术方案、术后并发症及生存期等。根据随访结果进行疗效及预后分析。结果甲状腺乳头状癌15例，滤泡状癌6例，乳头滤泡状癌2例。肿瘤局部侵犯喉返神经8例，侵犯气管12例，侵犯气管及食道3例，合并侵犯颈前肌群8例。23例均行手术治疗，其中肿瘤根治6例，肿瘤剔除14例，姑息性切除3例（2例术后加行局部放疗）。全组1、3、5年总生存率为91．3％（21／23）、82．6％（19／23）、60．8％（14／23）。其中根治组和剔除组预后明显好于姑息组。结论局部晚期分化型甲状腺癌手术治疗后仍能取得较好疗效，重视保护局部器官功能是提高术后生存质量的保证。

Clinical features and treatment analyses of local advanced well-differentiated thyroid carcinoma

Objective To investigate clinieopathologic characteristics and therapy of local advanced welldifferentiated thyroid carcinoma.Methods Data of 23 cases of advanced well-differentiated thyroid carcinoma treated from Jan.1996 to Dec.2005 were retrospectively reviewed.The data included age,pathologic type,local invasion,operative plan,postoperative complications and survival duration.Results Histology showed there were 15 cases of papillary carcinoma,6 ca8es of follicular carcinoma,and 2 cases of papiIlary follicular carcinoma.8 cases had local invasion into recurrent laryngeal nerve,12 cases had invasion into trachea,3 cases had trachea and esophagus invasion,and 8 cases had suprahyoid muscle invasion.All the 23 cases underwent resection procedure.According to surgical procedure,they were divided into radical resection group(n=6),tumor resection group(n=14)and tumor debulking group(n=3).2 cases received radiotherapy after thyroidectomy in tumor debulking group.All patients were followed up.Overall survival rate after 1 year,3 years and 5 years Was 91.3%(21/23),82.6%(19/23),and 60.8%(14/23)respectively.Prognosis of radical tumor removal group and tumor resection group was obviously better than that of tumor debulking group.Conclusions Prognosis is good for local advanced well-differentiated thyroid carcinoma patients receiving resection.Protection of local organ function Can enhance postoperative life quality.