PTC术中提示1~2枚中央区淋巴结转移选择不同手术方式的获益分析

Benefits of different surgical methods for 1-2 central lymph node metastases during operation of papillary thyroid carcinoma

摘要:

目的 探讨适用于术中1~2枚中央区淋巴结转移的甲状腺乳头状癌（papillary thyroid carcinoma，PTC）的手术方式。方法 收集2013年1月至2018年12月于重庆医科大学附属第一医院乳腺甲状腺外科行初次手术的术中1~2枚中央区淋巴结转移的PTC患者290例，并分析其临床病理学特征。结果 甲状腺腺叶切除术（hemithyroidectomy，HT）组的手术并发症发生率显著低于甲状腺全切除术（total thyroidectomy，TT）组（P<0.001）。手术方式不影响结构持续性/复发性疾病的发生（HR=2.848，95%CI=0.321~25.294，P=0.348）。淋巴结总转移数>5枚的独立危险因素为肿瘤直径>14.5 mm（OR=5.838，95%CI=2.295~14.850，P<0.001）、肿瘤位于上份（OR=2.765，95%CI=1.154~6.624，P=0.023）、Ⅲ区淋巴结有转移（OR=17.310，95%CI=7.053~42.481，P>0.001）。结论 目前结果支持术中提示1~2枚中央区淋巴结转移的PTC患者的首选手术方式为甲状腺腺叶切除术。若肿瘤位于上份且直径>14.5 mm，建议行预防性的同侧Ⅲ区颈淋巴结清扫。

Abstract:

Objective To explore the surgical method for papillary thyroid carcinoma（PTC） with 1-2 central lymph node metastases during surgery.Methods A total of 290 patients with PTC and 1-2 central lymph node metastases during the primary surgery in the Department of Breast and Thyroid Surgery of The First Affiliated Hospital of Chongqing Medical University were collected from January 2013 to December 2018，and their clinicopathological features were analyzed.Results The incidence of surgical complications in the hemithyroidectomy（HT） group was significantly lower than that in the total thyroidectomy group（P<0.001）. The surgical method did not affect the occurrence of structurally persistent/recurrent diseases（HR=2.848，95%CI=0.321-25.294，P=0.348）. The independent risk factors for total number of lymph node metastases >5 were tumor diameter >14.5 mm（OR=5.838，95%CI=2.295-14.850，P<0.001），tumor location in the upper part（OR=2.765，95%CI=1.154-6.624，P=0.023），and metastasis to zone Ⅲ lymph nodes（OR=17.310，95%CI=7.053-42.481，P<0.001）.Conclusion The current results support that the preferred surgical method for patients with PTC and 1-2 central lymph node metastases during surgery is HT. If the tumor is located in the upper part and has a diameter of more than 14.5 mm，it is recommended to undergo prophylactic ipsilateral neck lymph node dissection in zone Ⅲ.