多功能保留颈清扫术与改良式颈清扫术治疗分化型甲状腺癌的对比研究

Application of multi-functional and modified neck lymphadenectomy for treatment of cN1b differentiated thyroid carcinoma

摘要:

目的 探讨多功能保留颈清扫术与改良式颈清扫术治疗cN1b分化型甲状腺癌的疗效。方法 选取2012年5月—2017年1月江西省肿瘤医院收治的cN1b分化型甲状腺癌患者50例，按照随机数字表法分为观察组和对照组，每组25例。观察组行多功能保留颈淋巴结清除术，对照组行改良式颈淋巴结清扫术，所有患者随访6个月，比较两组患者治愈率、复发率、生存质量，以及抬肩困难、咽瘘、颈部变形、周围皮肤麻木等手术并发症发生情况。结果 治疗后观察组患者治愈率（92.00%）与对照组（88.00%）比较，差异无统计学意义（P?> 0.05）；观察组6个月内复发率（8.00%）与对照组（12.00%）比较，差异无统计学意义（P?>0.05）；治疗后观察组的生存质量总得分[（156.38±15.24）分]与对照组[（121.38±11.64）分]比较，差异有统计学意义（P?<0.05），观察组高于对照组；治疗后观察组抬肩困难、颈部变形手术并发症发生率与对照组比较差异无统计学意义（P?> 0.05）；治疗后观察组水肿、周围皮肤麻木手术并发症发生率与对照组比较差异均有统计学意义（P?<0.05），观察组均低于对照组。结论 多功能保留颈清扫术相比于改良式颈清扫术，不会增加患者复发风险，患者的生存质量更佳，周围皮肤麻木的发生率低，值得临床推广。

Abstract:

Objective To investigate the clinical application of multi-functional and modified neck lymphadenectomy for surgical treatment of cN1b differentiated thyroid carcinoma. Methods Fifty patients with differentiated thyroid cancer who were admitted into our hospital from May 2012 to January 2017 were randomly divided into observation group (n?=?25) and control group (n?=?25). The patients in observation group had multi-functional neck lymphadenectomy while patients in control group received modified neck lymphadenectomy. All patients were followed up for 6 months. The cure rate, relapse rate, quality of life, difficulty of raising the shoulder, pharyngeal fistula, neck deformity, numbness around the skin, and occurrence of surgical complications were recorded. Results No obvious difference in cure rate, recurrence rate, incidence of complications such as shoulder lifting difficulty and neck deformation were identified between two groups (P?>?0.05). Patients in observation group experienced increased levels of total score of quality of life and decreased incidence of complications such as edema and numbness of surrounding skin when compared with control group (P?