分化型甲状腺癌再次手术46例临床分析

目的探讨分化型甲状腺癌再次手术的原因和选择合理的手术方式。方法对甲状腺癌再次手术46例的资料进行回顾性分析并结合文献进行讨论。结果本组病例首次手术前均诊断为良性甲状腺疾病;首次手术方式肿物切除或甲状腺部分切除术28例,甲状腺次全切除术12例,甲状腺叶全切除术3例,甲状腺腺叶全切除+峡部切除+颈淋巴结切除3例。再次手术原因主要为甲状腺癌术前诊断率低、首次手术方式不当及肿瘤复发或颈淋巴结转移。结论由于甲状腺癌的术前误诊或首次手术方式不当,致术后的残癌率高,再次手术是必要的;术中冰冻病理切片检查是避免再次手术的关键;对于甲状腺癌切除术后复发或淋巴结转移者,应积极作合理的再次手术。

Objective To analyze the cause of renperation for differentiated thyroid cancer and how to choose appropriate operation for differentiated thyroid cancer. Methods Data of 46 cases of thyroid cancer undertaken reoperation were analyzed retrospectively. Results Causes for reoperation were as follows： residue of the tumor locally as the inappropriate initial operation ;local recurrence and cervical rervical lymph node metastasis; finding of tumor involvement of the contralateral thyroid or cervical lymph node. Conclusion As only a few cases of thyroid cancer can be diagnosed correctly before operation, most cases underwent excision of isthmus should take intraoperative rapid from section diagnosis, which is the key to avoid renperation , since reoperation has many risks. FS should be done on thyroid nodule patients. It＇ s proper to choose lobectomy plus isthmusectomy in uncertain cases with single or multiple thyroid nodules if FS impossible. As for those with local recurrence and cervical lymph node metastasis , a proper renperation should be done.