| 周 斌,秦建武.分化型甲状腺癌不同术式治疗后再手术相关问题探讨[J].中国肿瘤,2015,24(6):452-455. |
| 分化型甲状腺癌不同术式治疗后再手术相关问题探讨 |
| Discussion on the Related Issues about Reoperation Following Different Surgical Modes for Differentiated Thyroid Carcinoma |
| 投稿时间：2014-12-23 |
| DOI：10.11735/j.issn.1004-0242.2015.06.A004 |
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| 中文关键词: 分化型甲状腺癌 部分切除 再次手术 |
| 英文关键词:differentiated thyroid carcinoma resection reoperation |
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| 中文摘要: |
| 摘 要：［目的］ 探讨分化型甲状腺癌不同术式术后残癌率和颈部淋巴结转移情况。［方法］ 对在外院行不同术式治疗后来我院行二次手术的共147例分化型甲状腺癌患者进行总结分析。147例均行患侧侧颈淋巴结探查活检，如冰冻证实淋巴结转移，则行侧颈功能性颈部淋巴结清扫。［结果］再次术式：行患侧甲状腺残叶切除134例，行患侧Ⅵ区淋巴结清扫125例。总的残癌率为26.53%（39/147），行肿物切除的残癌率为34.00%（17/50），行部分切除的残癌率为34.78%（16/46），行次全切除的残癌率为15.79%（6/38），行腺叶切除的13例患者未见明确癌残留。患侧Ⅵ区淋巴结总转移率50.4%（63/125）。侧方淋巴结总转移率42.86%（63/147），且侧方淋巴结转移与原发灶肿瘤外侵相关（P<0.05）。因初次手术引起的声带麻痹率为9.52%（14/147）。［结论］ 分化型甲状腺癌行局部切除术后肿瘤残留率高，应尽可能避免该术式应用。部分切除后补充手术是必要的。对分化型甲状腺癌处理，需至少行患侧腺叶加峡部加同侧Ⅵ区淋巴结清扫，同时探查患侧侧颈淋巴结，根据冰冻结果决定是否清扫。 |
| 英文摘要: |
| Abstract：［Purpose］ To investigate the rate of residual cancer and lymph node metastasis of differentiated thyroid carcinoma following different operation modes postoperation. ［Methods］ One-hundred and forty-seven cases with differentiated thyroid carcinoma undergoing different surgical modes in other hospitals for second operation were analyzed. ［Results］ The second operation in the hospital included：134 cases with ipsilateral residual thyroid gland resection，125 cases with ipsilateral Ⅵ area lymph node dissection. The total residual carcinoma rate following the 2nd operation was 26.53%(39/147). Residual cancer rate of tumor enucleation was 34.00%(17/50)；partial resection 34.78%(16/46)；subtotal resection 15.79%(6/38). No definite residual cancer was found in 13 cases with lobectomy.The ipsilateral Ⅵ lymph node total metastasis rate was 50.4%(63/125). The lateral lymph node total metastasis rate was 42.86% (63/147)，and lateral lymph node metastasis was related to the primary tumor invasion (P<0.05). Due to the initial operation of vocal cord paralysis rate was 9.52%(14/147). ［Conclusion］ Local resection of thyroid gland for differentiated thyroid carcinoma has a high rate of residual cancer. This operation mode should be avoided as far as possible. After partial excision，the secondary surgery is necessary in the treatment for differentiated thyroid carcinoma. Unilateral lobe with isthmus plus ipsilateral Ⅵ region lymph node dissection is necessary. Lateral cervical lymph node exploration based the results of frozen section pathology determines whether dissection or not. |
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