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Clinical Analysis of Pathologically Negative Reoperation for Differentiated Thyroid Cancer
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摘要:
目的 分析分化型甲状腺癌再次手术组织病理阴性的可能原因。 方法 回顾性收集并分析2013年1月至2017年12月北京协和医院基本外科再次手术的分化型甲状腺癌患者临床资料。依据再次手术组织病理结果分为组织病理阴性组和组织病理阳性组。比较两组一般资料、首次手术临床资料、再次手术前超声声像特征及再次手术术式差异。 结果 共纳入218例符合纳入标准和排除标准的再次手术分化型甲状腺癌患者, 其中男性70例, 女性148例, 男女比例1:2.11;平均年龄(43.7±12.7)岁。所有患者均在术前临床诊断肿瘤复发转移, 其中组织病理阴性组27例, 组织病理阳性组191例。与组织病理阳性组相比, 组织病理阴性组患者年龄较大[(49.3±12.6)岁比(42.9±12.5)岁, P=0.013], 首次手术为多中心病灶的比率较低(7.4%比24.6%, P=0.045), 两组在性别、首次手术术式、肿瘤大小、再次手术前超声声像特征及再次手术术式方面无统计学差异(P均>0.05)。 结论 分化型甲状腺癌再次手术组织病理阴性病例并不少见。患者年龄及首次手术是否为多中心病灶可能与再次手术组织病理是否阴性有关。 Abstract:Objective The objective of this study was to analyze risk factors for pathologically negative reoperation in patients with differentiated thyroid cancer. Methods The clinical data of patients underwent reoperation for differentiated thyroid cancer from January 2013 to December 2017 in Peking Union Medical College Hospital were assessed retrospectively. Based on postoperative pathology, patients were further divided into pathology positive and negative groups. The demographic characteristics, operation information, pathological findings, and ultrasonography outcomes were compared between the two groups. Results A total of 218 patients were included. Seventy cases were males and 148 cases were females. The male to female ratio was 1:2.11. The average age was 43.7±12.7 years. All patients were diagnosed with local recurrence or metastasis before the reoperation. Twenty-seven patients had negative postoperatively pathological results, while other 191 had positive ones. Compared with the positive group, the patients of the negative group were older (49.3±12.6years vs. 42.9±12.5 years, P=0.013) and had fewer multifocal lesions (7.4% vs. 24.6%, P=0.045). The two groups had no significant difference in gender, operation information, tumor size, and ultrasonography outcomes (all P>0.05). Conclusions Pathologically negative reoperation for differentiated thyroid cancer is not rare. The age and multifocality of the primary surgery may be associated with negative reoperative pathology. -
Key words:
- differentiated thyroid cancer /
- multifocality /
- reoperation /
- pathology, negative
利益冲突 无 -
表 1 218例分化型甲状腺癌患者一般资料及首次手术情况比较
指标 组织病理阴性组
(n=27)组织病理阳性组
(n=191)P值 男性[n(%)] 7(25.9) 63(33.0) 0.462 年龄(x±s，岁) 49.3±12.6 42.9±12.5 0.013 术式[n(%)] 0.614 双侧腺叶切除+中央及
颈侧区淋巴结清扫6(22.2) 50(26.2) 双侧腺叶切除+中央及
淋巴结清扫6(22.2) 58(30.4) 单侧腺叶切除+中央及 5(18.5) 22(11.5) 淋巴结清扫 单侧腺叶切除 10(37.0) 61(31.9) 多中心病灶[n(%)] 2(7.4) 47(24.6) 0.045 肿瘤直径(x±s，cm) 1.2±0.7 1.3±0.8 0.633 侵犯包膜[n(%)] 6(22.2) 33(17.3) 0.719 有淋巴结转移[n(%)] 9(33.3) 83(43.5) 0.319 淋巴结转移数目
＞3个[n(%)]6(22.2) 44(23.0) 0.925 
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表 2 218例分化型甲状腺癌患者再次手术术式比较[n(%)]
术式 组织病理阴性组
(n=27)组织病理阳性组
(n=191)P值 0.133 残余腺叶切除+中央及颈侧区淋巴结清扫 2(7.4) 46(24.1) 残余腺叶切除+中央区淋巴结清扫 6(22.2) 29(15.2) 残余腺叶切除+颈侧区淋巴结清扫 2(7.4) 30(15.7) 残余腺叶切除 3(11.1) 10(5.2) 中央及颈侧区淋巴结清扫 3(11.1) 9(4.7) 中央区淋巴结清扫 0(0) 2(1.1) 颈侧区淋巴结清扫 11(40.7) 65(34.0)
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表 3 218例分化型甲状腺癌患者再次手术术前超声声像特征比较[n(%)]
术式 组织病理阴性组
(n=27)组织病理阳性组
(n=191)P值 残余腺体癌灶 3(11.1) 45(23.6) 0.144 淋巴结钙化或高回声 15(55.6) 101(52.9) 0.794 淋巴结皮髓质分界不清 15(55.6) 107(56.0) 0.441 淋巴结形态变圆 3(11.1) 37(19.4) 0.440 淋巴结周边型血流信号 2(7.4) 9(4.7) 0.897
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