青少年分化型甲状腺癌的再手术治疗(附36例报告)

Study on Reoperation Treatment of Differentiated Thyroid Carcinoma in Teenager: A Report of 36 Cases

目的 探讨青少年分化型甲状腺癌误诊误治原因及再手术指征、手术方式、并发症的预防。方法 对 11年来收治的3 6例再手术青少年分化型甲状腺癌临床资料进行回顾性分析。结果 再手术病理有残癌占 3 8 9% ,有颈部淋巴结转移占 3 0 5 %。再手术并发症 :声嘶 2例 ,手足抽搐 3例。再手术 5年生存率 90 4% ,10年生存率 88 9%。结论 青少年的甲状腺结节应高度警惕恶性变可能 ,FNAB(细针针吸细胞学检查 )可以帮助术前诊断 ,减少误诊 ,术中冰冻切片应列为常规 ,选择合理规范的术式 ,可提高手术切除率及患者的生存质量。

Objective To study the causes of misdiagnosis for differentiated thyroid carcinoma in teenager, the re-operative indication and style as well as the prevention of complication. Methods The clinical data of 36 cases of re-operative treatment for differentiated thyroid carcinoma in teenager from 1991 to 2002 were analyzed retrospectively.Results The incidence of residual cancer and cervical lymphnode metastasis in the patients was 38.9% and 30.5% respectively. The re-operative complications included 2 cases of hoarseness, and 3 cases of hand and foot spasm. Five-year and ten-year survival rates after reoperation were 90.4% and 88.9%, respectively. Conclusion Thyroid nodules in teenager should be guarded against malignancy. FNAB(Fine-Needle Aspiration Biopsy) is helpful for diagnosis before the operation, and pathological observation of frozen section during operation must be performed as routine examination. Choosing suitabel operative style could raise the operative excision rate and quality of life. The improved operation skill could reduce the operative complications.