Short term and long-term outcomes of the affected lobe combined with isthmus of the thyroid gland resection in the treatment of micropapillary thyroid cancer
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摘要: 目的 分析甲状腺患侧叶联合峡部切除术治疗甲状腺微小乳头状癌的近远期疗效,探讨治疗该病的最有效疗法。 方法 选取宁波市第二医院2007年1月—2008年12月收治的60例甲状腺微小乳头状癌患者,按照随机数表法分为对照组(30例)及观察组(30例),对照组应用甲状腺全切术联合中央区淋巴结清扫治疗,观察组应用甲状腺患侧叶联合峡部切除术治疗,对比2组患者的近期疗效(手术时间、术中出血量、切口长度、术后用药量、住院时间等临床相关指标,甲状旁腺素和血清钙水平,低钙血症、甲状腺功能减退、喉返神经损伤等并发症)与远期疗效(5年、10年的总缓解率、复发率、无瘤存活率、病死率)。 结果 观察组患者临床相关指标优于对照组;2组术后的甲状旁腺素和血清钙水平均较术前有所降低,但观察组的降低幅度小于对照组;观察组术后并发症发生率(10.0%)低于对照组(33.33%);各组差异均有统计学意义(均P<0.05)。观察组5年、10年的总缓解率、复发率、无瘤存活率、病死率均与对照组相当,差异无统计学意义(均P>0.05)。 结论 甲状腺患侧叶联合峡部切除术治疗甲状腺微小乳头状癌的近远期疗效优于甲状腺全切术联合中央区淋巴结清扫治疗,可明显改善患者甲状旁腺素和血清钙水平,减少并发症,降低复发率与病死率。Abstract: Objective To analyze the short-term and long-term effects of thyroidectomy combined with isthmus resection in the treatment of micropapillary thyroid cancer, and to explore the most effective treatment for this disease. Methods Sixty patients with micropapillary thyroid cancer in our hospital from January 2007 to December 2008 were enrolled and assigned into control group (n=30) and observation group (n=30) according to the random number table. The control group was treated with total thyroidectomy combined with central lymph node dissection, and the observation group was treated with thyroidectomy combined with isthmus resection. The short-term effect (operation time, intraoperative bleeding volume, incision length, postoperative medication dosage, hospitalization time, parathyroid hormone and serum calcium level, hypocalcemia, hypothyroidism, recurrent laryngeal nerve injury and other complications) and long-term effect (total remission rate, recurrence rate, tumor-free survival rate and fatality rate of 5 years and 10 years) were compared between the two groups. Results The clinical related indexes of the observation group were better than those of the control group; the levels of parathyroid hormone and serum calcium in both groups were lower than those before the operation, but the decrease of the observation group was less than that of the control group; the incidence of postoperative complications in the observation group (10.0%) was lower than that in the control group (33.33%); there was significant difference between the two groups (all P<0.05). The total remission rate, recurrence rate, tumor-free survival rate and fatality rate of the observation group were similar to those of the control group in 5 and 10 years, with no significant difference (all P>0.05). Conclusion The short-term and long-term effect of thyroidectomy combined with isthmus resection is better than that of total thyroidectomy combined with central lymph node dissection in the treatment of micropapillary thyroid cancer. It can obviously improve the levels of parathyroid hormone and serum calcium, reduce complications, and reduce recurrence rate and fatality rate.
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