118例甲状腺癌局部切除术后再手术探讨

The Discussion of Reoperation after Local Resection of Thyroid Cancer in 118 Cases

目的:了解甲状腺癌行肿块切除或腺叶次全切除术后腺体残癌率和区域淋巴结转移的情况,明确甲状腺癌的切除范围与手术方式。方法:对1994年8月～2005年2月在院外行肿块局部切除后来我院行2次或2次以上手术的118例甲状腺癌进行分析。结果:总癌残留率55.9%(66/118)。原发腺叶残癌率38.1%(45/118),对叶癌发现率7.6%(9/118),颈侧区淋巴结肿大的转移癌发生率为37.5%(21/56),患侧中央区淋巴结转移癌发生率为39.8%(47/118)。院外术后喉返神经损伤的发生率为15.2%(18/118),我院再次手术所致喉返神经损伤的发生率为1.6%(2/118)。结论:甲状腺癌行肿块切除或腺叶次全切除术后残癌率较高,此类术式应该废弃。甲状腺癌腺叶切除手术中应强调解剖喉返神经,可降低损伤发生率。临床颈淋巴结阴性患者,术中快速切片(FS)一经确诊分化型甲状腺癌,应常规行中央区淋巴结清扫术。

Objective： To evaluate the rate of residual disease in the thyroid gland and that of cervical lymph node metastasis, after preliminary local resections in thyroid cancer Methods： From 1994.8-2005.2, 118 thyroid cancer patients who had previously been treated with nodulectomy or subtotal lobectomy in other hospitals were reoperated Results： The rate of residual disease at the primary site was 38.1%. The lymph node metastasis rate at middle zero was 39.8%. The rate of lymph node metastasis in those with enlarged lymph nodes in the ipsilateral internal jugular chain was 37.5%. The rate of laryngeral recurrent nerve injury was 15.2% in other hospitals while that of the second operation in my hospital was 1.6% Conclusions： Nodulectomy or subtotal lobectomy alone is not indicated for thyroid cancer because of the high rate of local residual disease. It is important to be familiar with laryngeal recurrent nerve anatomy in thyroid surgery. The clearance of lymph nodes in central area is needed for differentiated thyroid cancer.