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目的:探讨分化型甲状腺癌围手术期循环血微转移存在状况及影响因素。方法:采用流式细胞术(FCM)对327例手术治疗的分化型甲状腺癌,围手术期检测外周血微转移并对其进行相关因素分析。结果:分化型甲状腺癌术前循环血微转移阳性93例(28.4%),其中74例(74/93)术后1周持续阳性、35例(35/74)术后4周仍呈阳性。循环血微转移在术前及术后1周阳性率与肿瘤大小、淋巴结分期有关(P<0.05),与病理分化程度无明显关系(P>0.05);在术后4周时微转移阳性率仅与肿瘤的病理分化程度有关(P<0.05)。在术前微转移阴性者中,有34例(17.3%)术后1周转呈阳性,其阳性率仅与肿瘤大小有关(P<0.001)。结论:分化型甲状腺癌循环血微转移与肿瘤大小、淋巴结分期及手术刺激密切相关,肿瘤分化程度是循环血微转移阳性持续存在的主要因素。
Objective: To investigate the perioperative circulating micrometastasis in differentiated thyroid cancer and its influencing factors. Methods: 327 cases of differentiated thyroid carcinoma treated by FCM were collected. Peripheral blood micrometastasis was detected during perioperative period and related factors were analyzed. Results: 93 cases (28.4%) had preoperative circulation blood micrometastasis in differentiated thyroid cancer, of which 74 cases (74/93) remained positive one week after operation and 35 cases (35/74) remained positive 4 weeks after operation. The positive rate of circulating blood micrometastases before surgery and one week after surgery was related to tumor size and lymph node staging (P <0.05), but not to pathological differentiation (P> 0.05). The positive rate of micrometastasis at 4 weeks after operation The degree of tumor differentiation (P <0.05). In the preoperative micrometastasis negative, 34 cases (17.3%) turned positive one week after operation, and the positive rate was only related to tumor size (P <0.001). Conclusion: Circulating blood micrometastasis in differentiated thyroid carcinoma is closely related to tumor size, lymph node staging and surgical stimulation. The degree of tumor differentiation is the main reason for the persistence of circulating micrometastasis.