From The Perspective Of Residual Disease To Explore The Operating Extent Of Thyroid Papillary Carcinoma

bjective:Through analyzing the medical records of patients,from the perspective of residual disease to explore the operating extent of thyroid papillary carcinoma.In order to provide certain clinical reference for the preoperative selection of surgical method.Methods :Colleced January 1,2012-December 31,2015 by postoperative pathology-Sichuan academy of medical sciences & Sichuan province People's hospital of thyroid surgery treated papillary thyroid cancer confiemed a total of 723 cases,560 cases were female,163 cases were male;the age of 11-82 years,mean age 41 years,?45 years were 435 cases,>45 years of age 291 cases;200 cases of patients with invasion and coating;multifocal cacer,221 cases including 71 cases of unilateral and 150 cases of both sides;186 cases with thyroid side lobe and isthmic excision,537 cases with total thyroidectomy,682 cases with central lymph node dissection,the line side of neck lymph node dissection in 304 cases.Apply SPSS 19.0 statistical software for statistical analysis of the results,data were ?2 test,P<0.05 was considered statistically significant.Analysis the potential relationship between different surgical methods and lesions residue.Study the relationship between the number of lesions,lesion distribution,lesion size and gender,age,capsule invasion,and their influence on the characteristics of PTC lesions and on the neck lymph node metastasis of central and side region.Exolore the operating extent of thyroid papillarycarcinoma.Results:As the lesions in diameter increase,the incidence of multifocal carcinoma increased gradually(P<0.01).With the increase of focal diameter,multifocal carcinoma with distribution increase gradually(P<0.01).Capsule invasion and no capsule invasion of multifocal cancer patients,the proportion of lesions in bilateral thyroid were respectively 78.0% and 64.2%(P=0.04).The central lymph node metastasis rate of patients with lesions diameter <1cm and >1cm were 41.4% and 68.4%(P<0.01),their neck lymph node metastasis rate were 16.9% and 46.9%(P<0.01).The central lymph node metastasis rate of patients with lesions diameter ?0.5cm and 0.6-1.0cm were 30.6% and 46.9%(P<0.01).The neck lymph node metastasis rate of patients with lesions diameter 1-2cm and 2-3cm were 39.3% and 64.7%(P<0.01).As the focal diameter increase,the central,neck lymph node metastasis rate increased(P<0.01,P<0.01).The central lymph node metastasis rate of patients with age ?45 years and >45 years were respectively 60.2% and 44.6%(P<0.01),,their neck lymph node metastasis rate were 32.9% and 23.5%(P<0.01).As the age increase,the central,neck lymph node metastasis rate increased(P<0.01,P<0.01).With the increase of the number of central lymph node,the neck lymph node metastasis rate increased(P<0.01).When the number of central lymph node was one and two,their neck lymph node metastasis rate was respectively 29.4% and44.6%(P=0.04).Conclusion: 1.Patients with diameter ?3cm and having no capsule invasion,multifocal carcinoma,lymph node metastasis can choose surgical method of unilateral lobe with isthmus resection.Patients with diameter > 3cm or having capsule invasion,multifocal carcinoma,lymph node metastasis should choose surgical method of total thyroidectomy.2.Frequently clean central lymph node and use of intraoperative frozen pathology.3.For patients whose diameter >3cm or lesion numbers >2 or number of central lymph node >2 can clean neck lymph node preventively,and other patients that outside the range need not clean neck lymph node.4.Don't need change the operation for reducing the surgical complications.