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预防性中央颈部淋巴结清扫术对分化型甲状腺癌行甲状腺全切除术并无短期获益。

Prophylactic Central Neck Lymph Node Dissection Adds No Short-Term Benefit to Total Thyroidectomy for Differentiated Thyroid Cancer.

机构信息

Department of Special Surgery, Medical Faculty, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria.

Department of Surgery, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria.

出版信息

Medicina (Kaunas). 2023 Jan 27;59(2):239. doi: 10.3390/medicina59020239.

Abstract

: To answer the research question: "Is prophylactic central neck lymph node dissection (pCNLD) beneficial among differentiated thyroid carcinoma (DTC) patients?" : This was a retrospective cohort study enrolling DTC patients treated at the University Hospital Kaspela, Bulgaria, from 30 January 2019 to October 2021. The predictor variable was presence of pCNLD (total thyroidectomy with vs. without pCNLD). The main outcome variables were postoperative complications (i.e., vocal cord paralysis, hypoparathyroidism, postoperative bleeding, and adjacent organ injury) and recurrence parameters. Appropriate statistics were computed with the significant level at ≤ 0.05. : During the study period, 300 DTC patients (59.7% with pCNLD; 79.3% females) with an average age of 52 ± 2.8 years were treated. The mean follow-up period of the entire cohort was 45.8 ± 19.1 months. On bivariate analyses, TT with pCNLD, when compared to TT alone, required longer surgical time (mean difference: 9.4 min), caused nearly similar complications (except transient hypothyroidism: = 0.04; relative risk, 1.32; 95% confidence interval, 1.0 to 1.73), and no significantly different recurrence events, time to recurrence, and recurrent sites. The benefit-risk analyses using the number needed to treat and to harm (NNT; NNH) also confirmed that TT plus pCNLD was not very beneficial in DTC management. : The results of this study refute the benefit of pCNLD in DTC patient care with TT. Further well-designed studies in a larger cohort with a longer follow-up period are required to confirm this conclusion.

摘要

: 为了回答研究问题:“预防性中央颈部淋巴结清扫术(pCNLD)对分化型甲状腺癌(DTC)患者有益吗?”:这是一项回顾性队列研究,纳入了 2019 年 1 月 30 日至 2021 年 10 月在保加利亚卡塞帕拉大学医院治疗的 DTC 患者。预测变量为 pCNLD 的存在(甲状腺全切除术伴或不伴 pCNLD)。主要结局变量为术后并发症(即声带麻痹、甲状旁腺功能减退、术后出血和邻近器官损伤)和复发参数。使用 ≤ 0.05 的显著性水平计算了适当的统计数据。: 在研究期间,治疗了 300 名 DTC 患者(59.7%行 pCNLD;79.3%为女性),平均年龄为 52 ± 2.8 岁。整个队列的平均随访时间为 45.8 ± 19.1 个月。在单变量分析中,与单独的 TT 相比,TT 加 pCNLD 需要更长的手术时间(平均差异:9.4 分钟),导致几乎相似的并发症(除了短暂性甲状腺功能减退:= 0.04;相对风险,1.32;95%置信区间,1.0 至 1.73),且复发事件、复发时间和复发部位无显著差异。使用需要治疗和需要伤害的数量(NNT;NNH)进行的获益-风险分析也证实,TT 加 pCNLD 在 DTC 管理中并没有很大的益处。: 这项研究的结果反驳了在 TT 中对 DTC 患者进行 pCNLD 的益处。需要在更大的队列中进行设计更好的、随访时间更长的研究来证实这一结论。

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