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目的总结多灶性甲状腺乳头状癌的临床病理学特征,评估全甲状腺切除+预防性中央区淋巴结清扫术在治疗多灶性甲状腺乳头状癌中的临床意义及安全性。方法回顾性分析2011年6月至2015年2月期间于湖北医药学院附属东风医院接受全甲状腺切除+预防性中央区淋巴结清扫术的103例多灶性甲状腺乳头状癌患者的病例资料。结果 103例多灶性甲状腺乳头状癌患者均行全甲状腺切除+预防性中央区淋巴结清扫术。单侧多发病灶55例(53.40%),双侧多发病灶48例(46.60%)。中央区淋巴结转移31例(30.10%),其中单侧多发病灶者中央区淋巴结转移16例(29.10%),均为患侧中央区淋巴结转移;双侧多发病灶者中央区淋巴结转移15例(31.25%),其中双侧转移7例,单侧转移8例。术后13例(12.62%)出现暂时性的低钙血症;1例(0.97%)发生永久性的甲状旁腺功能损伤;18例(17.48%)出现喉返神经短暂性麻痹,没有发生永久性喉返神经损伤的病例;3例(2.91%)术后出现短暂性饮水呛咳。术后所有患者均获访,随访时间为5个月~4年,中位数为28个月。随访期间3例(2.91%)出现侧颈区淋巴结转移。结论全甲状腺切除+预防性中央区淋巴结清扫术对治疗多灶性甲状腺乳头状癌有重要意义。
Objective To summarize the clinicopathological features of multifocal thyroid papillary carcinoma and evaluate the clinical significance and safety of total thyroidectomy plus prophylactic central lymph node dissection in the treatment of multifocal papillary thyroid carcinoma. Methods The clinical data of 103 patients with multifocal papillary thyroid carcinoma who underwent total thyroidectomy plus prophylactic central lymph node dissection at Dongfeng Hospital of Hubei Medical College from June 2011 to February 2015 were retrospectively analyzed. Results All 103 patients with multifocal thyroid papillary carcinoma underwent total thyroidectomy plus prophylactic central lymph node dissection. 55 cases were unilateral multiple lesions (53.40%), bilateral multiple lesions in 48 cases (46.60%). There were 31 cases of lymph node metastasis in the central area (30.10%). There were 16 cases (29.10%) of metastatic lymph nodes in the central area with unilateral multiple lesions, all of them were lymph node metastases in the central area of ipsilateral. ), Including bilateral metastasis in 7 cases, unilateral metastasis in 8 cases. Postoperative 13 cases (12.62%) had transient hypocalcemia; permanent parathyroid injury occurred in 1 case (0.97%); recurrent laryngeal nerve transient paralysis in 18 cases (17.48%) did not occur permanently Recurrent laryngeal nerve injury cases; 3 cases (2.91%) postoperative transient cough of drinking water. All patients were followed up for 5 months to 4 years with a median of 28 months. During the follow-up period, 3 cases (2.91%) had cervical lymph node metastasis. Conclusions Total thyroidectomy and prophylactic central lymph node dissection are important for the treatment of multifocal thyroid papillary carcinoma.