临床外科杂志 ›› 2022, Vol. 30 ›› Issue (12): 1168-1171.doi: 10.3969/j.issn.1005-6483.2022.12.020

• 论著 • 上一篇    下一篇

峡部扩大切除+患侧中央区淋巴结清扫术在长径≤1cm甲状腺微小乳头状癌中的应用

  

  1. 223300 江苏淮安,南京医科大学附属淮安第一医院甲乳外科 
  • 收稿日期:2022-02-21 接受日期:2022-02-21 出版日期:2022-12-20 发布日期:2023-01-20
  • 通讯作者: 甄林林,Email:njmu1201@126.com

Application of isthmus extended resection and lymph node dissection in the central area of the affected side in thyroid micro papillary carcinoma with length≤1cm

  1. Department of Breast and Thyroid Surgery,The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University,Jiangsu,Huai'an 223300,China
  • Received:2022-02-21 Accepted:2022-02-21 Online:2022-12-20 Published:2023-01-20

摘要: 目的 探究峡部扩大切除结合患侧中央区淋巴结清扫术在长径≤1cm甲状腺微小乳头状癌中的应用。方法 2015年1月~2017年1月我院就诊的甲状腺微小乳头癌病人164例,根据手术方式分为两组,对照组74例,行患侧甲状腺腺叶切除+峡部切除,观察组90例,行甲状腺腺叶切除+峡部切除+患侧中央区淋巴结清扫术。统计两组病人手术情况、咽部反流症状指数量表(RSI)、声音障碍指数量表(VHI)评分、并发症发生率与随访情况。结果 两组病人失血量、住院时间、暂时性喉返神经损伤发生率、低钙血症发生率与甲状腺旁腺功能低下发生率比较,差异均无统计学意义(P>0.05)。手术前与手术1周后,两组病人RSI评分与VHI的各项评分比较,差异无统计学意义(P>0.05),手术1周后两组病人的RSI评分与VHI的各项评分均低于手术前,差异有统计学意义(P<0.05)。观察组手术时间长于对照组(P<0.05),6个月复发率、1年复发率和1年淋巴结转移率均低于对照组,5年生存率高于对照组,差异有统计学意义(P<0.05)。结论 峡部扩大切除+患侧中央区淋巴结清扫术的实施对长径≤1cm甲状腺微小乳头状癌病人咽部与声音无影响,可降低术后复发率,且不增加术中失血量,可提高病人生存率。

关键词: 峡部扩大切除, 中央区淋巴结清扫术, 甲状腺微小乳头癌, 外科

Abstract: Objective To explore the application of extended isthmus resection combined with lymph node dissection in the central area of the affected side in the treatment of thyroid micro papillary carcinoma with length ≤1cm.Methods The data of 164 patients with thyroid papillary carcinoma treated in Huai'an First Hospital Affiliated to Nanjing Medical University from January 2015 to January 2017 were analyzed retrospectively.According to the operation method,they were divided into control group(74 cases) and observation group(90 cases).The control group received thyroidectomy + isthmus resection on the affected side,and the observation group received thyroidectomy + isthmus resection + central lymph node dissection on the affected side.The operation situation,pharyngeal reflux symptom index (RSI),voice disturbance index (VHI),complication rate and follow-up of the two groups were counted.Results There was no significant difference in blood loss,length of hospital stay,incidence of temporary recurrent laryngeal nerve injury,incidence of hypocalcemia and incidence of parathyroid gland dysfunction between the two groups (P>0.05).There was no significant difference in RSI scores and VHI scores between the two groups before operation and 1 week after operation (P>0.05).The RSI scores and VHI scores of the two groups after 1 week of operation were lower than those before operation (P<0.05).The operation time of the observation group was longer than that of the control group(P<0.05).The 6 month recurrence rate,1 year recurrence rate and 1 year lymph node metastasis rate of the observation group were lower than those of the control group The 3 year survival rate was higher than that in the control group (P<0.05).Conclusion The implementation of isthmus extended resection + central lymph node dissection on the affected side has no effect on the pharynx and sound of patients with thyroid micro papillary carcinoma with length ≤1cm.It can reduce the incidence of complications and recurrence rate without increasing intraoperative blood loss,and can significantly improve the survival rate of patients.

Key words: isthmus expansion resection, central lymph node dissection, thyroid papillary carcinoma, surgery

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