甲状腺乳头状癌伴发桥本甲状腺炎行甲状腺全切手术后生存质量分析

doi:10.3969/j.issn.1005-6483.2021.08.019

摘要/Abstract

摘要： 目的：探讨甲状腺乳头状癌(PTC)伴发桥本甲状腺炎(HT)行甲状腺全切术后生存质量。方法：2015年1月~2019年2月PTC伴发HT行甲状腺全切术病人82例，统计病人术后12个月生存质量情况。采用Karnofsky功能状态评分(KPS)评价病人生存质量。采用单因素分析影响甲状腺全切术后生存质量相关因素；采用多因素Logistic回归分析影响甲状腺全切术后生存质量独立危险因素。结果：所有病人均完成12个月随访，平均KPS评分(77.25±13.19)分。单因素分析显示，不同性别、体质指数、合并基础疾病、TSH水平、TgAb阳性、TPOAb阳性、手术时间、术中出血量、术后低血钙、术后甲状旁腺功能减退、术后口服甲状腺素片和术后采用131I治疗病人KPS评分比较差异无统计学意义(P>0.05)；年龄＞60岁病人KPS评分低于年龄≤60岁，肿瘤直径＞5cm病人KPS评分低于肿瘤直径≤5cm，Ⅲ~Ⅳ期病人KPS评分低于Ⅰ~Ⅱ期，淋巴结转移病人KPS评分低于无淋巴结转移，肿瘤包外侵犯病人KPS评分低于无肿瘤包外侵犯，差异有统计学意义(P<0.05)。经多因素Logistic回归分析显示，年龄＞60岁、肿瘤直径＞5cm、Ⅲ~Ⅳ期、淋巴结转移和肿瘤包外侵犯为影响甲状腺全切术后生存质量独立危险因素。结论：PTC伴发HT病人行甲状腺全切术后生存质量受多因素影响，其中年龄、肿瘤大小、临床分期、淋巴结转移和肿瘤包外侵犯为影响术后生存质量独立危险因素。

关键词: 甲状腺乳头状癌, 桥本甲状腺炎, 甲状腺全切术, 生存质量

Abstract: Objective：To investigate the quality of life after total thyroidectomy for papillary thyroid carcinoma(PTC) with Hashimoto's thyroiditis(HT).Methods：The 82 patients with PTC complicated with HT underwent total thyroidectomy in our hospital from January 2015 to February 2019 were retrospectively analyzed,and the quality of life of patients 12 months after operation was statistically analyzed.Karnofsky functional status score(KPS) was used to evaluate the quality of life.Univariate analysis was used to analyze the related factors affecting the quality of life after total thyroidectomy;multivariate logistic regression analysis was used to analyze the independent risk factors of quality of life after total thyroidectomy.Results：All patients were followed up for 12 months,the average KPS score was(77.25±13.19).Univariate analysis showed that there were no significant differences in KPS scores among different gender,body mass index,underlying diseases,TSH level,TGAb positive,TPOAb positive,operation time,intraoperative blood loss,postoperative hypocalcemia,postoperative hypoparathyroidism,postoperative oral thyroxine tablets and postoperative 131I patients(P>0.05);KPS score of patients with age > 60 years old was lower than that of patients with age≤60 years old,KPS score of patients with tumor>5 cm was lower than that of patients with tumor≤5 cm,KPS score of patients with stage ⅢⅣ was lower than that of patients with stage ⅠⅡ,and KPS score of patients with lymph node metastasis was lower The KPS score of patients with extraperitoneal invasion was lower than that without lymph node metastasis(P<0.05).Multivariate logistic regression analysis showed that age>60 years old,tumor>5 cm,stage ⅢⅣ,lymph node metastasis and tumor extracapsular invasion were the independent risk factors affecting the quality of life after total thyroidectomy.Conclusion：The quality of life in patients with PTC complicated with HT after total thyroidectomy is affected by many factors,including age,tumor size,clinical stage,lymph node metastasis and tumor invasion.

Key words: papillary thyroid carcinoma, Hashimoto's thyroiditis, total thyroidectomy, quality of life

穆静辉, 冯文静. 甲状腺乳头状癌伴发桥本甲状腺炎行甲状腺全切手术后生存质量分析[J]. 临床外科杂志, 2021, 29(8): 761-763.

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