【作者】 向俊；

【导师】 吴毅； 李端树； 沈强； 王卓颖；

【作者基本信息】 复旦大学 ， 肿瘤学， 2008， 硕士

【摘要】 目的:研究甲状腺癌临床特点的变化。方法:1996年与2006年我院头颈外科分别手术治疗初治甲状腺癌148例与572例,按时间分为1996年组与2006年组,对照分析其临床资料。应用SPSS11.0统计软件进行统计分析。以P＜0.05作为差别有统计学意义的标准。主要采用卡方检验x~2和t检验比较两组数据间差别。结果:2006年组甲状腺癌为572例,是1996年组148例的3.86倍。1996年组男女之比1:1.96,中位年龄42岁;2006年组男女之比为1:3.80,中位年龄44岁。1996年组4例(2.7%)因超声普查发现肿瘤就诊,2006年组为285例(49.82%)。1996年与2006年超声诊断灵敏度分别为86.66%与88.20%。甲状腺癌原发灶病理均以乳头状癌为主,1996年乳头状癌占87.84%,2006年占92.83%。2006年直径0-1cm(35.70%)与1-2cm(38.50%)甲状腺癌所占比例均多于1996年(20.27%与27.02%),P＜0.01。1996年原发灶外侵共46例(31.08%),2006年39例(6.82%),P＜0.01。1996年组中央区淋巴结转移共98例(66.21%),2006年组301例(52.62%),P＜0.05。2006年组侧颈部淋巴结转移117例(20.5%),1996年组37例(25%),P＞0.05。中央区淋巴结转移率以及侧颈部淋巴结转移率均与甲状腺癌直径呈正相关,P＜0.05。2006年Ⅰ期甲状腺癌病例比例高于1996年,P＜0.01。2006年组甲状腺微癌主要发现方式是超声普查(81.86%)。甲状腺癌增长的构成以0-1cm(40.56%)与1-2cm(41.89%)乳头状癌为主。结论:早期的甲状腺癌越来越多见,其主要原因是由于甲状腺癌临床特点的变化,如原发灶直径变小,原发灶外侵减少,颈部淋巴结转移率降低。而引起这些变化的原因可能是超声普查已成为发现甲状腺癌的主要方式之一。中央区淋巴结转移率以及侧颈部淋巴结转移率均与甲状腺癌直径呈正相关。甲状腺癌发病率的增高的重要因素可能是由于超声检查等诊断技术的普及致使甲状腺癌检出率升高。加强超声普查对甲状腺结节的筛查可以早期发现甲状腺癌,从而达到早发现,早诊断,早治疗的目的。更多还原

【Abstract】 Objective To discuss the new clinical features of thyroid cancer.Methods Review and compare the patients with thyroid cancer,1996 and 2006,using the clinical data from the Department of head & neck surgery in Cancer hospital of Fudan University,Shanghai,China.The comparison of clinical features were analysed,where relevant,by Chi-square test and t-test.SPSS version 11.0(SPSS Inc,Chicago,IL) software was used in the data analysis.Results are summarized by P values and those less than significance level 0.05 are considered statistically significant.Results The patient of thyroid cancer increased from 148 cases in 1996 to 572 cases in 2006 -a 3.86-fold increase.In 1996,male:female was 1:1.96.The mean age was 42y.In 2006,male:female was 1:380.The mean age was 44y.Ultrasound survey in routine health check found 4 thyroid cancer cases(2.7%) in 1996 and 285 cases(49.82%) in 2006.The sensitivity of the ultrasound in thyroid cancer was 86.66%in 1996 and 88.2%in 2006(P>0.05).The papillary carcinoma was the mainly pathological type(87.84%in 1996 and 92.83%in 2006).The ratio of small cancer was increasing.The microcarcinoma occupied 35.70%in 2006 while 20.27%in 1996(P<0.01).And Tumor with the diameter from 1cm to 2cm owned 38.5%in 2006 and 27.02%in 1996(p<0.01).There were 46(31.08%) cases of the extrathyroid extension of primary tumor in 1996 and 39(6.82%) cases in 2006(P<0.01).There were 98(66.21%) cases in 1996 that had central cervical lymph node metastasis while 301(52.62%) cases had in 2006(P<0.05).There were 37(25.0%) cases in 1996 that had lateral cervical lymph node metastasis while 117(20.5%) cases had in 2006(P>0.05).Both the rate of central cervical lymph node metastasis and the rate of lateral cervical lymph node metastasis had the positive correlation with the diameter of thyroid cancer(P<0.05).The ratio of cases in stage I in 2006 was obviously higher than that in 1996.In 2006, there were 81.86%of microcarcinoma found by ultrasound survey in general physical examination.The increasing thyroid cancer was mainly contributed to papillary microcarcinoma(40.56%) and the papillary carcinoma in 1-2cm(41.89%).Conclusion With the increasing incidence of thyroid cancer,more thyroid cancers in early stage have been found in clinic.It is contributed to the new clinical features of thyroid cancer,such as the decrease in tumor’s diameter,the decrease of extrathyroid cancer and the decrease of the cervical lymph node metastasis.Ultrasound survey in routine health has become the most common way to found thyroid cancer.Both the rate of central cervical lymph node metastasis and the rate of lateral cervical lymph node metastasis had the positive correlation with the diameter of thyroid cancer.We believe the suggests that increased diagnostic scrutiny such as the ultrasound has caused an apparent increase in incidence of thyroid cancer by detecting small cancers.We have to pay more attention to the ultrasound survey to screen more thyroid cancer in early stage in order to have better therapeutic effect.更多还原