甲状腺肿瘤初次手术切除范围探讨

Initial Operation in patients with Thyroid Neoplasms

目的 :分析甲状腺肿瘤再次手术原因 ,探讨初次手术甲状腺腺叶切除范围。方法 :回顾分析复旦大学附属金山医院 1988年 1月～ 2 0 0 3年 1月收治的 10 1例甲状腺肿瘤再次手术病人。结果 :男性 14例 ,女性 87例 ,中位年龄 4 1岁 (18～ 6 9岁 )。甲状腺肿瘤再次手术率为 12 .9% (10 1/ 781) ,肿瘤残留或复发占 6 7.3% (6 8/ 10 1) ,初次手术病理为良性肿瘤 ,再次手术癌检出率为2 0 .7% (17/ 82 ) ,再次手术并发症发生率为 12 .9% (13/ 10 1)。结论 :甲状腺肿瘤初次手术腺叶切除范围不够是导致肿瘤残留或复发的主要原因 ,甲状腺良性肿瘤术后再次手术有较高的癌检出率 ,再次手术有较高的并发症发生率。建议甲状腺肿瘤初次手术行单侧腺叶 +峡部切除

Objective: To investigate the causes of reoperations on patients with thyroid neoplasms and the criteria for initial surgery. Methods: Thyroid reoperations were performed on 101 patients in our hospital from January 1988 to 2003.Informations related to operative procedures,pathology,and complications were analysed retrospectively. Results: There were 87 women and 14 men with a mean age of 41 years(rang,18-69). The rate of reoperation was 12.9%(101/781). Remnant or recurrence occurred in 68cases(67.3%),Cancer occurred in 17(20.7%)cases of the 82 reoperations in patients who in initially had benign neoplasms. The postoperative complications occurred in 11 patients(12.9%). Conclusion:The main causes of remnant or recurrence or cancerization of thyroid neoplasms were inadequate primary thyroid operations(tumour excision or partial lobectomy).The complication rate is higher in thyroid reoperation than in primary thyroid operation. Therefore, we suggest upon patient with thyroid neoplasms, primary operation should be unilateral lobectomy plus isthmusectomy plus frozen section.