预防性颈中央区淋巴结清扫术与传统甲状腺全切除术治疗甲状腺癌的效果对比

章文杰

[摘要]目的 探讨预防性颈中央区淋巴结清扫术与传统甲状腺全切除术治疗甲状腺癌的效果对比情况。方法 分析中山火炬开发区医院2007年1月～2012年1月收治的甲状腺癌患者50例临床资料，依据手术方式不同进行分组，对照组（传统甲状腺全切除术）20例和观察组（预防性颈中央区淋巴结清扫术）30例。观察两组手术时间、术中出血量、暂时性低钙血症发生率、永久性低钙血症发生率、术后5年复发率、术后颈侧方向淋巴结转移发生率和生存率情况。结果 观察组手术时间长于对照组，术中出血量多于对照组，术后5年复发率、术后颈侧方向淋巴结转移发生率和生存率均低于对照组，差异均有统计学意义（P<0.05）。两组暂时性低钙血症发生率和永久性低钙血症发生率差异无统计学意义（P>0.05）。结论 预防性颈中央区淋巴结清扫术治疗甲状腺癌患者，可以降低低钙血症发生率，预后良好，值得临床推广应用。

[关键词]预防性颈中央区淋巴结清扫术；传统甲状腺全切除术；甲状腺癌

[中图分类号] R736.1 [文献标识码] A [文章编号] 1674-4721（2018）5（b）-0079-03

Comparison of preventive cervical lymph node dissection and conventional total thyroidectomy for thyroid cancer

ZHANG Wen-jie

The First Department of Surgery，Hospital of Torch Development District in Zhongshan City，Guangdong Province，Zhongshan 528437，China

[Abstract]Objective To investigate the effect comparison of preventive cervical central lymph node dissection and conventional total thyroidectomy in the treatment of thyroid cancer.Methods The clinical data from 50 patients with thyroid cancer who were admitted to our department from January 2007 to January 2012 were analyzed.According to different surgical methods，they were divided into control group （n=20，traditional total thyroidectomy） and observation group（n=30，preventive cervical central lymph node dissection）.The operative time，intraoperative blood loss，incidence of temporary and permanant hypocalcemia，recurrence rate 5 years after surgery，incidence of postoperative cervical lymph node metastasis and survival rate in two groups were observed.Results The operative time in the observation group was longer than that in the control group.The intraoperative blood loss was more，the 5-year recurrence rate after surgery，postoperative cervical lymph node metastasis rate，and the survival rate were all lower compared with those in the control group.The differences were statistically significant（P<0.05）.There was no significant difference in the incidence of temporary/permanent hypocalcemia between the two groups（P>0.05）.Conclusion Preventive cervical central lymph node dissection for thyroid cancer patients can reduce the incidence of hypocalcemia and obtains a good prognosis，which is worthy of clinical application and promotion.

[Key words]Preventive cervical central lymph node dissection；Conventional total thyroidectomy；Thyroid cancer

甲狀腺癌是人体常见的恶性肿瘤，其瘤体生长相对缓慢，手术预后较好，10年生存率高于90%[1-2]。临床研究表明[3-4]，甲状腺癌行甲状腺全切除术治疗，加上颈淋巴结清扫联合根治术有较好的效果，但对预防性颈中央区淋巴结清扫术有一定的争议。颈中央区淋巴结上界达到舌骨，外侧界到达颈总动脉内侧，下方达到胸骨切迹或是无名动脉以上[5-6]。预防性颈中央区淋巴结清扫术是否实施需从多个角度考虑，手术范围扩大是否增加低钙血症发生率风险性和是否可提高预后水平，成为研究的热点问题。……