实用癌症杂志
實用癌癥雜誌
실용암증잡지
The Practical Journal of Cancer
2015年
10期
1513-1517
,共5页
分化型甲状腺癌%甲状腺腺叶切除术%全甲状腺切除术%颈淋巴结清扫%预后
分化型甲狀腺癌%甲狀腺腺葉切除術%全甲狀腺切除術%頸淋巴結清掃%預後
분화형갑상선암%갑상선선협절제술%전갑상선절제술%경림파결청소%예후
Differentiated thyroid cancer%Thyroid lobectomy%Total thyroidectomy%Prophylactic cervical lymph node dis-section%Prognosis
目的：对比研究三种不同术式治疗分化型甲状腺癌患者10年内的生存状况。方法232例Ⅰ～Ⅲ期分化型甲状腺癌病患者据手术方式分组：①单侧腺叶切除组；②全甲状腺切除组；③全甲状腺切除＋预防性中央区颈淋巴结清扫组。采用Kaplan-Meier法、Log-rank检验及COX回归模型作生存分析。结果⑴三组患者术后喉返神经损伤、喉上神经损伤及甲状旁腺损伤发生率比较均无显著性差异，第③组术后24 h内出血发生率显著高于另外两组（ P＝0．028）；⑵复发风险：第①组术后累积复发风险显著高于第②组（P＝0．000）和第③组（P＝0．000），后两组之间无显著性差异（P＝0．057）；⑶死亡风险：第①组术后累积死亡风险高于第②组（P＝0．000）和第③组（P＝0．000），后两组之间无显著性差异（P＝0．937）；⑷预后因素：手术方式、年龄及病理类型是分化型甲状腺癌复发及死亡的主要影响因素。结论手术方式直接影响分化型甲状腺癌患者术后生存状况，年龄≥45岁、滤泡状癌患者预后较差。
目的：對比研究三種不同術式治療分化型甲狀腺癌患者10年內的生存狀況。方法232例Ⅰ～Ⅲ期分化型甲狀腺癌病患者據手術方式分組：①單側腺葉切除組；②全甲狀腺切除組；③全甲狀腺切除＋預防性中央區頸淋巴結清掃組。採用Kaplan-Meier法、Log-rank檢驗及COX迴歸模型作生存分析。結果⑴三組患者術後喉返神經損傷、喉上神經損傷及甲狀徬腺損傷髮生率比較均無顯著性差異，第③組術後24 h內齣血髮生率顯著高于另外兩組（ P＝0．028）；⑵複髮風險：第①組術後纍積複髮風險顯著高于第②組（P＝0．000）和第③組（P＝0．000），後兩組之間無顯著性差異（P＝0．057）；⑶死亡風險：第①組術後纍積死亡風險高于第②組（P＝0．000）和第③組（P＝0．000），後兩組之間無顯著性差異（P＝0．937）；⑷預後因素：手術方式、年齡及病理類型是分化型甲狀腺癌複髮及死亡的主要影響因素。結論手術方式直接影響分化型甲狀腺癌患者術後生存狀況，年齡≥45歲、濾泡狀癌患者預後較差。
목적：대비연구삼충불동술식치료분화형갑상선암환자10년내적생존상황。방법232례Ⅰ～Ⅲ기분화형갑상선암병환자거수술방식분조：①단측선협절제조；②전갑상선절제조；③전갑상선절제＋예방성중앙구경림파결청소조。채용Kaplan-Meier법、Log-rank검험급COX회귀모형작생존분석。결과⑴삼조환자술후후반신경손상、후상신경손상급갑상방선손상발생솔비교균무현저성차이，제③조술후24 h내출혈발생솔현저고우령외량조（ P＝0．028）；⑵복발풍험：제①조술후루적복발풍험현저고우제②조（P＝0．000）화제③조（P＝0．000），후량조지간무현저성차이（P＝0．057）；⑶사망풍험：제①조술후루적사망풍험고우제②조（P＝0．000）화제③조（P＝0．000），후량조지간무현저성차이（P＝0．937）；⑷예후인소：수술방식、년령급병리류형시분화형갑상선암복발급사망적주요영향인소。결론수술방식직접영향분화형갑상선암환자술후생존상황，년령≥45세、려포상암환자예후교차。
Objective To study the survival of different surgical procedures for differentiated thyroid cancer .Methods According to different surgical methods ,232 cases of differentiated thyroid cancer were divided into 3 groups including thyroid lo-bectomy group ( Group 1) ,total thyroidectomy group ( Group 2) and total thyroidectomy plus prophylactic neck dissection group (Group 3).Kaplan-Meier,Log-rank and COX regression were used to study survival .Results ⑴There was no significant differ-ence in incidence of unilateral recurrent laryngeal nervous injury ,superior laryngeal nervous injury and parathyroid injury of the 3 groups,incidence of postoperative hemorrhage in group 3 was higher than the other 2 groups (P=0.028);⑵Cumulative recurrent hazard in the group 1 had higher risk than group 2 (P=0.000) and group 3 (P=0.000),there was no significant difference be-tween group 2 and group 3 (P=0.057);⑶Cumulative death hazard in group 1 had higher risk than group 2 (P=0.000) and group 3 (P=0.000),respectively,there was no significant difference between the other 2 groups (P=0.937);⑷Prognostic fac-tors:surgical procedures ,age and pathological type were main influencing factors affecting recurrence and survival .Conclusion Postoperative survival quality of differentiated thyroid cancer patients are directly correlated with surgical procedures ,patients over 45 years old and follicular type have bad prognosis .
