甲状腺癌再手术36例治疗分析

The reoperation of thyroid carcinoma(with a clinical analysis of 36 cases)

目的探讨甲状腺癌再次手术的必要性及手术方式,分析再次手术的原因和手术的适应证.方法回顾性分析我院于1999年2月～2004年5月本人所在医院接收36例甲状腺癌再手术病例的临床资料.结果首次行甲状腺肿块切除术20例,患侧腺体部分切除术8例,患侧腺体次全切除术5例,甲状腺癌改良根治性颈淋巴清扫术3例.首次手术后的病理类型:乳头状癌32例,滤泡状腺癌3例,髓样癌1例.根据外院手术治疗资料及我院术前彩色多普勒超声检查或CT检查结果,均再次行手术治疗,其中再次行患侧甲状腺残叶+峡部切除者6例,行患侧甲状腺残叶+峡部切除+功能性颈清扫术27例,患侧复发病灶切除术2例,对侧甲状腺切除+对侧功能性颈清扫术1例.再次手术后病理检查证实癌残留的18例(54.5%),颈部淋巴结有转移癌20例(71.4%).随访至今均生存.结论甲状腺癌行局部肿块切除术,残癌率高,再次手术是必要的.强调术中快速冰冻病检在甲状腺手术中的常规应用,选用恰当的手术方式,是避免甲状腺癌再次手术的关键.

Objective To investigate the necessity and methods of reoperation for patients with thyroid carcinoma and to analyze the causes and indication of reoperation. Methods A retrospective analysis was made on the clinical data of 36 cases with thyroid carcinoma who were reopcrated from February 1999 to May 2004. Results Among the 36 cases, 20 patients were treated with local mass resection, 8 patients were performed with partial thyroidectomy, 8 patients were treated with subtotal thyroidectomy, and 3 patients were performed with modified radical thyroidectomy. Pathological types of thyroid carcinoma were as follows after first operation ： 32 cases were papillary cancer, 3 cases were follicular cancer and 1 case was medullary cancer. According to the clinical materials of other hospitals and examinations besides neck color Doppler or CT in our hospital, all patients were reoperated. 6 patients were retreated with residual lobectomy plus isthmus, 27 patients were treated with modified radical thyroidectomy, 2 patients were treated with recurrence loci resection and 1 patient was treated with thyrosdectomy and modified radical thyroidectomy on the other side. 18 cases were pathologically proved the residual carcinoma at the primary site （54.8 % ）, 20 cases were pathologically proved metastasis of the lymph nodes （71.4%）. All the patients survive now. Conclusion Because of the high residual cancer rate of local mass resection for thyroid carcinoma, reoperation is necessary. The key of avoiding reoperation is to emphasize the routine application of quick pathologic diagnosis during operation and select the best suitable surgical method.