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目的分析甲状腺乳头状癌不规范手术的弊端,探讨甲状腺乳头状癌不规范手术后补救手术的必要性和方式。方法总结1990年1月—2000年1月因行甲状腺乳头状癌不规范手术后又在浙江省肿瘤医院头颈外科补救手术的332例和同期在头颈外科行初次规范手术的甲状腺乳头状癌561例的临床及病理资料,对相关内容进行对比。结果补救手术者术后病理证实原发灶区肿瘤阳性率53·9%(179/332),颈淋巴转移率39·2%(130/332),颈前肌保存率30·7%(102/332),甲状旁腺明确保存率74·1%(246/332),喉返神经损伤发生率3·3%(11/332),原发灶区5年复发率7·5%(25/332),总的5年、10年累积生存率分别90·2%、84·4%。初次治疗者颈淋巴转移率37·4%(210/561),颈前肌保存率96·1%(539/561),甲状旁腺明确保存率93·0%(522/561),喉返神经损伤发生率1·2%(7/561),原发灶区5年复发率3·7%(21/561),总的5年、10年累积生存率分别94·0%、92·5%。全组原发灶区复发患者10年累积生存率67·8%,未复发患者10年累积生存率92·9%。统计学分析显示补救组与初次组间颈前肌保存率、甲状旁腺明确保存率、原发灶区5年复发率的差异有统计学意义(P<0·01);喉返神经损伤发生率差异也有统计学意义(P<0·05)。复发患者生存率低于无复发者,差异有统计学意义(P<0·01)。结论甲状腺乳头状癌不规范手术后原发灶区有较高的肿瘤阳性率,有必要行补救手术,但即使补救手术仍将导致较高的复发率,进而影响生存状况。同时二次手术将增加功能损伤的发生率,因而首次手术的规范化不容忽视。
Objective To analyze the malpractice of nonstandard operation of papillary thyroid carcinoma and to explore the necessity and the way of reoperation after thyroid papillary carcinoma unconventional operation. Methods From January 1990 to January 2000, there were 332 cases of head and neck surgeries in Zhejiang Tumor Hospital after irregular operation of thyroid papillary carcinoma and 561 cases of papillary thyroid carcinoma of the first standard operation in head and neck surgery department in the same period. The clinical and pathological data, the relevant content for comparison. Results The postoperative pathology confirmed that the positive rate of tumor in primary tumor area was 53.9% (179/332), cervical lymph node metastasis rate was 39.2% (130/332), and the preservation rate of anterior cervical muscle was 30.7% (102) / 332), the positive preservation rate of parathyroid gland was 74.1% (246/332), the incidence of recurrent laryngeal nerve injury was 3.3% (11/332), and the 5-year recurrence rate of primary focal area was 7.5% (25/25) / 332), the cumulative 5-year, 10-year cumulative survival rates were 90.2% and 84.4%, respectively. The rate of cervical lymph node metastasis was 37.4% (210/561), 96.1% (539/561) in the first treatment, 93.0% (522/561) in the parathyroid, The incidence of neurological injury was 1.2% (7/561). The 5-year recurrence rate in primary tumor area was 3.7% (21/561). The cumulative 5-year and 10-year cumulative survival rates were 94.0% and 92.0% 5%. The 10-year cumulative survival rate was 67.8% in patients with primary tumor recurrence and 92.9% in 10-year non-relapse patients. Statistical analysis showed that there was a significant difference in the preservation rate of anterior cervical muscle between the rescue group and the first group, the definite preservation rate of parathyroid gland, and the 5-year recurrence rate in the primary focus area (P <0.01). The recurrent laryngeal nerve injury occurred The difference was also statistically significant (P <0 · 05). The survival rate of patients with recurrence was lower than those without recurrence, the difference was statistically significant (P <0.01). Conclusion There is a high positive rate of tumor in the primary tumor area after the non-standard operation of papillary thyroid carcinoma. It is necessary to rehabilitate the thyroid papillary carcinoma. However, even the remedial surgery will lead to a high recurrence rate and further affect the survival status. At the same time the second surgery will increase the incidence of functional injury, and therefore the standardization of the first surgery can not be ignored.