CAJ | 학술논문

目的分析妊娠相关分化型甲状腺癌的临床特点,研究妊娠对分化型甲状腺癌的影响.方法回顾性分析青岛大学医学院附属医院普外科2001年1月至2011年1月生育年龄女性分化型甲状腺癌住院患者资料234例,根据妊娠情况将其分为未妊娠组(57例)、妊娠相关组(包括妊娠期间及分娩后1年内确诊患者共47例)、有妊娠生育史组(130例),对其临床特点及预后进行评估.结果妊娠相关组患者通过查体发现甲状腺结节比例(78.7％)明显高于其他两组(P=0.02),其确诊年龄、住院时间、手术时间、手术方式、肿瘤病理类型、肿瘤T分期及死亡率与其他两组患者无明显差异,但妊娠相关组腺体包膜外侵犯(P =0.024)、肿瘤多灶性(P =0.023)、颈部淋巴结最大直径平均值(P=0.021)、N分期(P =0.020)、局部复发(P=0.001)均与其他两组差异有统计学意义,逐步逻辑回归分析发现妊娠为影响局部复发的因素之一(P =0.045).结论妊娠不影响分化型甲状腺癌患者的远期死亡率,但妊娠相关分化型甲状腺癌患者更易出现包膜外侵犯、多灶性癌、颈部淋巴结转移及局部复发.
목적 분석임신상관분화형갑상선암적림상특점,연구임신대분화형갑상선암적영향.방법 회고성분석청도대학의학원부속의원보외과2001년1월지2011년1월생육년령녀성분화형갑상선암주원환자자료234례,근거임신정황장기분위미임신조(57례)、임신상관조(포괄임신기간급분면후1년내학진환자공47례)、유임신생육사조(130례),대기림상특점급예후진행평고.결과임신상관조환자통과사체발현갑상선결절비례(78.7％)명현고우기타량조(P=0.02),기학진년령、주원시간、수술시간、수술방식、종류병리류형、종류T분기급사망솔여기타량조환자무명현차이,단임신상관조선체포막외침범(P =0.024)、종류다조성(P =0.023)、경부림파결최대직경평균치(P=0.021)、N분기(P =0.020)、국부복발(P=0.001)균여기타량조차이유통계학의의,축보라집회귀분석발현임신위영향국부복발적인소지일(P =0.045).결론 임신불영향분화형갑상선암환자적원기사망솔,단임신상관분화형갑상선암환자경역출현포막외침범、다조성암、경부림파결전이급국부복발.
Objective To analyze the clinical features of differentiated thyroid cancer diagnosed during pregnancy or one year after delivery. Methods A total of 234 women with differentiated thyroid cancer were treated from January 2001 to January 2011.Cases were divided into three groups according to the time of tumor diagnosis( group 1,no pregnancy history; group 2,during pregnancy or in the first year after delivery;group 3,longer than 1 year after the delivery). Results The thyroid nodule was asymptomatic and discovered on routine examination more often in group 2(78.7％ ) than other two groups (P =0.02).There were no significant difference among three groups in age,hospitalization time,operation time,operation method,tumor type,primary tumor stage and mortality. But more patients in group 2 were suffering from extrathyroid invasion ( P =0.024 ),multi-focal cancer ( P =0.023 ),larger cervical lymph node ( P =0.021 ),later regional lymph node stage (P =0.020 ) and higher local recurrence (P =0.001 ).By stepwise logistic regression analysis,pregnancy is one of the factors impacting on local recurrence rate ( P =0.045 ).Conclusions Pregnancy does not affect the mortality of the differentiated thyroid cancer,but the incidence of extrathyroid invasion,multi-focal cancer,cervical lymph node metastasis,local recurrence is higher in patients with differentiated thyroid cancer diagnosed during pregnancy.