Analysis Of The Surgical Treatment And Diagnosis Of Patients With Thyroid Papillary Carcinoma

Objective:The objective to evaluate reasonable disease characteristics, diagnostic, surgical treatment, extent of lymph node dissection of papillary thyroid carcinoma(PTC) and postoperative adjuvant therapy for post-operational recurrence-related factors. This article will provide references for improving the prognosis thyroid carcinoma.Methods:The clinical and clinicopathologic data of 61 patients with radical operation of papillary thyroid carcinoma which have been confirmed at the first affiliated hospital of Dalian Medical University from March 2007 to February 2010 were analyzed retrospectively. Influences of disease on the prognosis were analysised according to the operation mode and cervical lymph node the scope of dissection. All the statistics used were precessed by SPSS 14.0 statistical software, P< 0.05 was considered statistically significant.Results:The ratio for man to women was 1:2.8, and there was a significant difference between genders. The peak age of papillary thyroid carcinoma was between 31-50 years old, and the average age was 45.6 years old. Operative method of PTC:2 cases were bilateral total thyroidectomy; 9 cases were bilateral subtotal thyroidectomy; 50 cases were total affected thyroidectomy plus isthmus and opposite subtotal thyroidectomy. The scope of the lymph node dissection:2 cases were radical lymph node dissection; 26 cases were modified radical lymph node dissection; 32 cases were selective (levelⅥ)lymph node dissection. Postoperative pathology:Unilateral thyroid papillary carcinoma 47 cases, bilateral thyroid papillary carcinoma 11 cases, isthmus thyroid papillary carcinoma 3 cases. The total rate of cervical lymph node metastasis was 26.6%(136/511). Metastases that occurred in central region(levelⅥ) and lateral region (levelⅡ～Ⅴ) lymph nodes were 11 cases and 5 cases,17 cases were metastases at central region and lateral region at the same time. Postoperatively,3 cases appeared local recurrences; 2 cases after the second surgery appeared distant metastases. Survival rate was 100% follow-up from 2 month to 3 years. 131Ⅰradiation therapy should be executed for patients with distant metastasis. Cervical lymph node metastases were related to tumor size, local invasion significantly.Conclusion:1. In this group, thyroid papillary carcinoma patients focused on 31～50 years-old people. PTC was characterized by a devastating illness, and there is no specific clinical manifestations or low preoperative diagnosis rate.2. The most operative program of PTC was total affected thyroidectomy plus isthmus and opposite subtotal thyroidectomy. High-risk patients can also be treated individually projects according t o the tumor location, clinical stages and comprehensive conditions of patients.3. For PTC patients with stage cN0, the selective lymph node dissection should be executed according to lymph node pathology results. PTC patients with stage cNl should operate modified radical lymph node dissection.4. Standard operation mode and thyroid surgeon training should be emphasized on reducing the complications and improving the quality of life after the surgery.5. The patients of thyroid carcinoma postoperatively should take thyroxine preparation for longtime to prevent tumor recurrence and metastasis. Patients should accept 131Ⅰradiation therapy and follow-up for longtime if it is necessary.