分化型甲状腺癌137例临床诊治分析

目的分析分化型甲状腺癌治疗的临床效果，探讨其合理的治疗方式。方法回顾性分析2002-2012年期间在我院普外科诊治的137例分化型甲状腺癌患者的临床及术后随访资料。结果本组137例分化型甲状腺癌患者均行个体化手术、Ⅵ区淋巴结常规清扫及术后综合治疗。淋巴结转移率为53．28％（73／137），Ⅵ区淋巴结术中病理证实为阳性者加行Ⅱ＋Ⅲ＋Ⅳ区淋巴结清扫，术后病理证实淋巴结转移率为41．10％（30／73）。多因素分析显示是否穿透被膜、病理类型及TNM分期是影响Ⅵ区淋巴结转移的独立危险因素（P〈0．05）。本组无围手术期死亡病例发生，住院期间出现暂时性声音嘶哑4例（2．92％），短期低钙血症11例（8．03％）。术后随访1-10年（平均6．5年），发现局部复发5例（3．65％）；颈淋巴结转移11例（8．03％）；远处转移3例（2．19％），其中1例骨转移，2例肺转移；再手术16例（11．68％）。结论个体化手术方式选择、Ⅵ区淋巴结常规清扫、密切随访管理是减少术后并发症发生及保障分化型甲状腺癌治疗效果的有利因素。

Clinical Analysis of Diagnosis and Treatment for 137 Patients with Differentiated Thyroid Cancer

Objective To analyze the clinical effective of differentiated thyroid cancer and approach the correct treatment methods for it. Method The clinical and postoperative follow-up data of 137 patients with differentiated thy- roid cancer treated in this hospital from 2002 to 2012 were analyzed retrospectively. Results One hundred and thirty- seven patients accepted individualization surgery, conventional VI region lymph node dissection, and postoperative com- prehensive therapy. The rate of lymph node metastasis was 53.28% （73/137）. VI region lymph node was confirmed to be positive by pathology which performed 11 ＋ 1I q- 1V region lymph node dissection, the rate of lymph node metastasis was 41.10% （30/73）. Multivariate analysis showed that penetrate capsule, pathologic type, and TNM stage were the independent risk factors for lymph nodes metastasis （P〈 0. 05）. No death occurred perioperative period. The temporary hoarseness was found in 4 cases （2.92%）, short-term hypocalcemia in 11 cases （8.03%）. During postoperative average 6. 5 years of follow-up, there were 5 cases （3.65%） of local recurrence, 11 cases （8.03%） of cervical lymph node meta- stasis, 3 cases （2. 19%） of distant metastasis including 1 case of bone metastasis and 2 cases of pulmonary metastasis, and 16 cases （11.68%） of reoperation. Conclusion Individualized surgical options, conventional VI region lymph node dissection, and close follow-up management could reduce the postoperative complications and guarantee the treatment effect of differentiated thyroid cancer.