中国实用外科杂志

中国实用外科杂志

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2015版美国甲状腺协会指南cN0甲状腺乳头状癌手术方案合理性分析

刘    文，程若川，苏艳军，刁    畅，钱    军，张建明，马云海   

  1. 昆明医科大学第一附属医院甲状腺疾病诊治中心，云南昆明 650032
  • 出版日期:2017-05-01 发布日期:2017-04-28

  • Online:2017-05-01 Published:2017-04-28

摘要：

目的    结合单中心数据讨论2015版美国甲状腺协会（ATA）指南推荐手术方案的合理性。方法    回顾性分析2007年1月至2016年6月昆明医科大学第一附属医院甲状腺诊治中心收治的初次手术（甲状腺切除+常规中央区淋巴结清扫）的2745例cN0甲状腺乳头状癌（PTC）病人的临床资料，分析各侵袭性表现与肿瘤直径关系。结果    单因素分析显示，中央区淋巴结转移（P<0.001）、侧方淋巴结转移（P<0.001）、腺外浸润（P<0.001）、不良病理亚型（P=0.027）均与肿瘤直径相关。侵袭性表现组与无侵袭性表现组［（1.00±0.02）cm vs. （0.91±0.02）cm，P=0.001］、中央区淋巴结阳性组与阴性组［（1.01±0.02）cm vs. （0.88±0.02）cm，P<0.001］的肿瘤直径差异有统计学意义。结论    2015版ATA指南中关于对大部分直径≤1 cm结节不常规推荐评估，1～4 cm的cN0病人不常规推荐全或近全甲状腺切除，不推荐对T1、T2和cN0病人行预防性中央区淋巴结清扫的观点较保守，可能不适用于所有病人，将其作为我国病人的常规手术方案推荐尚缺乏证据。

关键词: 2015版美国甲状腺协会指南, 甲状腺乳头状癌, 甲状腺切除术, 淋巴结清扫

Abstract:

Surgical planning and rational analysis of cN0 papillary thyroid carcinoma for 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer        LIU Wen，CHENG Ruo-chuan，SU Yan-jun，et al.  Diagnosis and Treatment Center of Thyroid Diseases，the First Affiliated Hospital of Kunming Medical University，Kunming 650032，China
Corresponding author：CHENG Ruo-chuan，E-mail：cruochuan@foxmail.com
Abstract    Objective    To discuss whether the recommended surgical procedures by 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer are reasonable through evidence of the big data in one single center. Methods    The postoperative pathological data of 2745 cases of papillary thyroid carcinoma underwent an initial operation（thyroidectomy+conventional central lymph node dissection） from January 2007 to June 2016 in Diagnosis and Treatment Center of Thyroid Diseases，the First Affiliated Hospital of Kunming Medical University were analyzed retrospectively. The relationship between invasiveness and tumor diameter was analyzed. Results    Univariate analysis showed the central lymph node metastasis（P<0.001），lateral lymph node metastasis（P<0.001），extrathyroidal invasion（P<0.001），adverse pathologic subtypes（P=0.027） were all associated with the tumor diameter. The mean diameter of invasion positive group was（1.00±0.02）cm，and the mean diameter of invasion negative group was （0.91±0.02）cm（P=0.001）. The mean diameter of the central lymph node positive group was （1.01±0.02）cm，and the mean diameter of the central lymph node negative group was （0.88±0.02）cm（P<0.001）. Conclusion    Some opinions in 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer are conservative，such as irregular recomemended evaluation for mojortiy of nodules diameter ≤1 cm and 1-4 cm cN0 patients，and non-recommnedation for taking prophylactic central lymph node dissection. And they may not be suitable for all patients and more valid evidences are required to regulate those recommendations as a regular plan for patients in China.

Key words: American Thyroid Association guidelines（2015 edition）, papillary thyroid carcinoma, thyroidectomy, lymph node dissection