全甲状腺切除联合中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌的疗效分析

Therapeutic efficacy of total thyroidectomy combined with central lymph node dissection in multifocal PTC

摘要:

目的 探讨全甲状腺切除联合中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌（PTC）的疗效。方法 选取2020年1月—2022年1月在马鞍山市人民医院治疗的多灶性PTC患者90例，采用信封法将患者分为观察组和对照组，每组45例。对照组给予全甲状腺切除，观察组给予全甲状腺切除联合中央区淋巴结清扫术，观察两组手术时间、术中出血量等，比较两组手术前后甲状旁腺激素（iPTH）、血钙、甲状腺球蛋白（Tg）、乏氧诱导因子-1α（HIF-1α）等指标的差异。结果 观察组手术时间、术中出血量高于对照组（P <0.05）。观察组治疗前后iPTH、血钙、Tg、CEA、HIF-1α的差值高于对照组（P <0.05）。观察组喉返神经短暂性麻痹、甲状旁腺功能减退和低血钙发生率高于对照组（P <0.05）。观察组术后无复发转移，优于对照组（P <0.05）。结论 全甲状腺切除联合中央区淋巴结清扫术治疗多灶性PTC有一定效果，可明显降低患者血清肿瘤标志物水平，术后复发转移发生率低，但其存在手术时间长、并发症多等缺点。

Abstract:

Objective To investigate the therapeutic efficacy of total thyroidectomy combined with central lymph node dissection in multifocal papillary thyroid carcinoma (PTC).Methods Ninety patients with multifocal PTC who were treated in our hospital from January 2020 to January 2022 were selected, and they were divided into the observation group (n = 45) and the control group (n = 45) by the envelope method. The control group was given total thyroidectomy, and the observation group was given total thyroidectomy combined with central lymph node dissection. The operative duration and intraoperative blood loss of the two groups were observed, and the differences of levels of intact parathyroid hormone (iPTH), blood calcium, thyroid globulin (Tg), and hypoxia-inducible factor-1α (HIF-1α) before and after the operation were compared.Results The operative duration was longer and intraoperative blood loss was greater in the observation group than in the control group (P < 0.05). The differences of levels of iPTH, blood calcium, Tg, carcinoembryonic antigen (CEA) and HIF-1α before and after the operation in the observation group were higher than those in the control group (P < 0.05). The incidence of transient paralysis of recurrent laryngeal nerve, hypoparathyroidism and hypocalcemia in the observation group was higher than that in the control group (P < 0.05). The incidence of postoperative recurrence and metastasis in the observation group was 0.00%, which was lower than that in the control group (P < 0.05).Conclusions Total thyroidectomy combined with central lymphadenectomy exhibits therapeutic efficacy in multifocal PTC. It significantly reduces the serum levels of tumor markers and lowers the incidence of postoperative recurrence and metastasis. However, it has the disadvantages of long operative duration and multiple complications.