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1、·246·中华普通外科学文献(电子版)2010年6月第4卷第3期ChinArchGenSurg(ElectronicEdition),June2010,Vol4,No.3·论著·分化型甲状腺癌外科手术方式探讨周宏姚陈赖远辉罗光辉陈永年【摘要】目的探讨不同条件下分化型甲状腺癌(DTC)手术方式的选择与预后的关系。方法收集DTC患者325例的临床资料,采用分层Cox回归分析的方法,回顾性分析其影响预后的因素。校正其他因素后,评价不同的手术方式与分化型甲状腺癌预后的关系。结果患者性别、年龄、复发与否、临床病理分期、肿瘤大小、手术治疗方式均为预后的影响因素(P<0.05);Cox多因素分析表明,年
2、龄、治疗方式和临床病理分期对其预后影响有统计学意义(P<0.05)。对年龄分层分析表明,与甲状腺全切组比较,高龄组单侧腺叶或加峡部切除为最佳手术方式(OR=0.320),低龄组不同手术方式OR值差异无统计学意义。根据临床病理分期分层,Ⅰ期采用单侧腺叶切除预后较好(OR=0.228),高分化期患者甲状腺次全切预后较好(OR=0.561)。结论年龄、治疗方式和临床病理分期是影响分化型甲状腺癌预后的主要因素,针对患者不同年龄、临床病理分期及患者耐受情况,采取最优的手术方式。【关键词】分化型甲状腺癌;预后;甲状腺肿瘤Investigationofsurgicaloperationalmodefor
3、differentiatedthyroidcancerZHOUHong*,YAOChen,LAIYuan-hui,LUOGuang-hui,CHENYongnian.DepartmentofGeneralSurgeryofXinhuiPeople鸳sHospital,Jiangmen529100,ChinaCorrespondingauthor:LAIYuan-hui,Email:skywalker_chenyao@yahoo.com.cn【Abstract】ObjectiveToinvestigatetheoperationalmodeofdifferentiatedthyroidcar
4、cinoma(DTC)indifferentconditionanditsrelationshipwithprognosis.MethodsRetrospectiveanalysistheclinicaldataof325casesofDTCtreatedfrom1993to2000,andaccordingthemainfactorsinfluencingprognosis,wedostratifiedanalysisusingmultivariatecoxregressionmodelbycorrectedconfoundedfactors,toevaluatetherelations
5、hipbetweensurgicaloperationalmodeandprognosisofDTC.ResultsThefactorsthatinfluencedtheprognosisofDTCincludedgender,age,recurrence,clinicopathologicalstage,primarytumorsize,andtreatmentpattern(P<0.05),butonlyage,treatmentpatternandclinicopathologicalstageinfluencedtheprognosisofDTCaccordingtoCoxmult
6、ivariateanalysis(P<0.05).Stratifiedbyage,hemithyroideetomyswithisthmusresectionswasthebestwayinthehigheragegroup,andtakingtotalthyroidectomyasreference,it'sORwas0.320.Butintheloweragegroup,therewasnosignificantstatisticaldifferenceinoperationalmode.Takingclinicopathologicalstageasastratifiedfactor
7、,hemithyroideetomywasagoodchoice(OR=0.228)instageⅠ,butinthehigerstage,subtotalthy-roidectomyseemedbetter(OR=0.561).ConclusionsAge,operationalmodeandclinicopathologicalstagearemainfactorsthatinfluencedtheprognosis