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Received:February 20, 2023 Published Online:November 20, 2023
Received:February 20, 2023 Published Online:November 20, 2023
中文摘要: 目的 分析分化型甲状腺癌(DTC)合并桥本甲状腺炎(HT)的临床特征,比较不同手术方式的疗效。方法 回顾性分析2018年1月至2019年5月辽宁省肿瘤医院初治的692例DTC患者的资料,按照是否合并HT分为DTC组(n=485)和DTC合并HT(DTC-HT)组(n=207),比较两组临床特征和术后并发症的差异。结果 两组在性别、微小癌、多发灶、甲状腺侵犯、颈淋巴结转移、再次手术、甲状腺过氧化物酶抗体方面差异有统计学意义(P<0.05)。DTC-HT组无血流信号比例高于DTC组,差异有统计学意义(47.8% vs 39.0%, χ2=4.684,P=0.030)。DTC-HT组中甲状腺全切和非甲状腺全切患者术后第1天引流量、一过性低钙血症及暂时声音嘶哑发生率差异无统计学意义(P>0.05)。结论 DTC合并HT患者以女性居多,多为微小癌,具有多发灶的特点,且术后残余腺体易发现新的癌灶,常需二次手术,应有计划地进行甲状腺全切除加患侧中央区淋巴结清扫术。
Abstract:Objective To explore the clinical characteristics of differentiated thyroid cancer (DTC) combined with Hashimoto's thyroiditis (HT), and to compare the efficacy of different surgical methods. Methods A retrospective analysis was conducted on data from 692 patients with DTC initially treated at Liaoning Cancer Hospital & Insititute from January 2018 to May 2019. The patients were divided into DTC group (n=485) and DTC combined with HT (DTC-HT) group (n=207). Clinical characteristics and postoperative complications were compared between two groups. Results There were statistically significant differences between two groups in terms of gender, microcarcinoma, multifocality, thyroid invasion, neck lymph node metastasis, reoperation, and thyroid peroxidase antibody (P<0.05). The proportion of patients with no blood flow signal in the DTC-HT group was higher than that in the DTC group (47.8% vs 39.0%, χ2=4.684,P=0.030). There was no statistically significant difference in drainage volume at the first day after operation, transient hypocalcemia, and temporary hoarseness between total thyroidectomy and non-total thyroidectomy patients in the DTC-HT group (P>0.05). Conclusion Patients with DTC combined with HT often present with microcarcinomas and multifocality, mainly females. After surgery, residual thyroid tissue may reveal new lesions, often necessitating a second surgery. Planned total thyroidectomy with ipsilateral central lymph node dissection should be considered.
keywords: Thyroid cancer, differentiated Hashimoto's thyroiditis Total thyroidectomy Microcarcinoma Lymph node dissection Blood flow signal Hypocalcemia
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基金项目:辽宁省自然科学基金(2020-ZLLH-34)
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