Management For The Carc .Noma CNo Patient With Differentiated Thyroid And Influential Factor Analysis

Objective:To evaluate the optional management for the cNopatient with differentiated thyroid carcinoma and influential factor analysis.Method:Retrospective analysis of 81cases of cNo with differentiated thyroid carcinoma between 1997 and 2007. Lobectomy for tumor side plus isthmusectomy plus subtotal lobectomy for another side and Lobectomy for tumor side plus isthmusectomy was performed in 62cases,total thyroidectomy was performed in 13cases , isthmusectomy plus subtotal lobectomy .Subtotal lobectomy for both sides plus isthmusectomy was performed in 6 cases. All of the cases were performed with neck dissection of the region VI .81 cases were divided into groups by age and tumor size,according to the staging of TNM of UICC 2002, and discussed the influential factors of lymph node metastasis of the region VI.Result : The 10,5 and 3 years survival rates were 100%.The lateral neck lymph nodes metastasis was appeared in lcase and elective neck dissection was performed .3 case lost flup. Other cases have lived without tumor. 3 of 6 cases operated with total thyroidectomy suffered hypopthyroidism in 4-7 days,but the hypothyroidism symptom disappeared after 4-7 days. There was no hypothyroidism and hypoperthyroidism in other cases .No recurrent nerve paralysis occurred except 3 patients who had recurrent nerve paralysis preoperative .The incidence of metastatic disease in the lymph nodes in the region VI was 36% (29/81).Metastasis to region VI lymph nodes account for 37%(13/35) in the group of above 45 years and metastasis to region VI lymph nodes account for 35%(16/46) in the group of below 45 years. The metastatic rate of lymph nodes in region VI was 44%(14/32) in the group of tumor size below 2cm and the metastatic rate of lymph nodes in region VI was 46%(18/39) in the group of tumor size between 2cm and 4cm.Conclusion : We recommend the neck dissection of region VI is performed in the same time of thyroidectomy is necessary for the cNo patient with DTC and we also recommend long term flup.