【作者】 李振东； 刘关文； 董慧蕾； 李树春；

【Author】 Li Zhen-Dong Dong Hui-Lei Li Shu-Chun Department of Head and Neck, Liao Ning Tumour Hospital, Shenyang 110042,China

【机构】 辽宁省肿瘤医院； 辽宁省营口市中医医院；

【摘要】 目的:分析有周围侵犯的高分化甲状腺癌的外科治疗,总结其临床经验。方法:回顾性分析1984年-2000 年在辽宁省肿瘤医院进行手术治疗,周围有侵犯的高分化甲状腺癌患者201例的临床资料。生存统计采用Kaplan-Meier 法,组间比较采用Log—Rank检验,多因素分析采用Cox 模型。结果:全喉、颈段部分气管切除3例,气管部分切除6例;喉、气管表面剔除67例;喉返神经切除9例;喉返神经表面剔除26例;包括带状肌、胸锁乳突肌、颈内静脉、迷走神经等周围软组织切除90例。201例中合并食道受累肌层切除19例,局部拉拢缝合,其中4例用胸锁乳突肌、 2例用胸大肌瓣局部加固修补。甲状腺一侧叶及峡部切除 189例;一侧腺叶及对侧次全切除5例;全甲状腺切除7例。颈清扫术129例(双颈清扫5例),共134侧,其中经典性颈清扫75侧;改良性颈清扫59侧。5年为生存率85．6％; 10年生存率为77．3％;15年生存率为69．4％。Cox模型分析显示年龄、肿瘤侵范部位是影响预后的独立因素。结论: 有周围侵袭的高分化甲状腺癌经过恰当的外科治疗,可以取得较好的疗效。更多还原

【Abstract】 Objective: To analyze the surgical data of well-differentiated thyroid carcinoma with local invasion, for acquiring the clinical experience. Methods: An retrospective analysis was made in 201 cases with well-differentiated invading thyroid carcinoma (WITC) in liaoning tumour hospital from 1984 to 2000.The data were statistically treated for survival curves according to the Kaplan meier method,The log-rank tests were employed to asses the statistical significance of various groups. Results: In these patients, There were 3 cases with total laryngec-tomy and partial cervical trachea resection, 6 cases with partial cervical trachea resection, 67 cases with shaving off tumor from its surface, 9 cases with recurrent laryn-geal nerve resection, 26 cases with shaving off tumor from the surface of recurrent laryngeal nerve. Other local structures invaded in 90 cases was resected with the thyroid tumour en bloc.189 cases with one thyroid lobe and isthmus gectomy, 5 cases one lobe and obsite subtotall gectomy.129 cases simutenous neck dissection(5 cases bilateral neck dissection),in them,75 neck radical neck dissection, 59 neck modified dissection.The 5-year, 10-year and 15-year living rates of well-differentiated thyroid carcinoma patients were 85.6%, 77.3% and 69.4% respectively. Multivariate analysis showed that patients’ age, tumour invading structure were independent prognostic factors. Conclusion: With proper operation, a better cure will be made in well-differentiated invading thyroid carcinoma.更多还原