甲状腺乳头状癌术式探讨(附62例分析)

Treatment of Thyroid Papillary Carcinoma:A Report of 62 Cases

目的探讨甲状腺乳头状癌合理的手术治疗方法。方法回顾分析我科62例甲状腺乳头状癌的临床资料。本组行患侧腺叶、峡部切除17例,患侧腺叶、峡部全切加对侧部分切除13例,患侧腺叶、峡部切除加对侧次全切22例,甲状腺全切9例,1例峡部癌行峡部全切加双侧腺叶次全切。对30例颈淋巴结肿大和5例中央区淋巴结清扫阳性的N0患侧行治疗性颈淋巴结清扫(以下简称颈清),其中患侧改良颈清28例,患侧根治颈清3例,双侧改良颈清4例;27例N0中央区淋巴结清扫阴性未进一步颈清。结果全组无手术死亡,治疗性颈清组淋巴结转移74.3%(26/35),中央区淋巴结受累88.5%(23/26)。随访4～6年2例高龄患者死于其他疾病,1例颈部复发合并肺转移带瘤生存,3例淋巴结复发再次手术无瘤生存。治疗性颈清组与中央区清扫组复发率分别为5.7%(2/35),7.4%(2/27)(P>0.05)。结论对于甲状腺乳头状癌,宜根据具体情况行患侧腺叶、峡部切除或加行对侧次全(或大部)切除;淋巴结肿大者应予患侧治疗性颈清;对于N0病例行中央区淋巴结清扫并行术中冰冻切片病理检查,阴性者观察随访,阳性者行患侧治疗性颈清。

Objective To investigate the correct surgery treatment for thyroid papillary carcinoma. Methods The clinical data of 62 patients with thyroid papillary carcinoma were analyzed retrospectively. Lobectomy and isthmectomy for tumor side and subtotal lobectomy for another side was performed in 22 cases; Lobectomy and isthmectomy for tumor side and partial lobectomy for another side was performed in 13 cases ; Lobectomy and isthmectomy was performed in 17 cases ; Total lobectomy was performed in 9 cases; Isthmusectomy and bilateral subtotal lobectomy was performed in 1 cases of isthmuse carcinoma. 30 cases with enlargement of lymph nodes and 5 NO cases detected positive lymph after central region lymph node dissected were treated with therapeutic neck dissection, in these patients,28 cases of modified neck dissection,3 cases of radical neck dissection for tumor side and 4 cases of bilateral modified neck dissection were performed respectively. Advanced neck dissection was not performed in 27 NO cases with negative dissected central region lymph node. Results Followed up 4 ～ 6 years postoperatively, there was no operative death in this group, rate of lymph node metastasis was 74.3% （26/35） in therapeutic neck dissection group,the central region lymph node metastasis was 88.5 % （23/26）. 2 elder patients died of other disease, 1 case of neck recurrence with lung metastasis was survived with tumor,3 cases of lymphatic recurrence survived without tumor after second surgery. The local recurrence rate was 5.7% （ 2/35 ） and 7.4% （ 2/27 ） （ P 〉 0.05 ） respectively in therapeutic neck dissection group and central region dissection group. Conclusions It was recommended that lobectomy for tumor side plus isthmectomy with （without） subtotal lobectomy or partial lobectomy for another side should be carried out in the patients diagnosed as papillary thyroid carcinoma; Therapeutic neck dissection should be performed in patients with enlarged lymph node; For the patients of clinic NO, central region dissection with fast pathologic examination of lymph node was recommended, patients with negative lymph node can be followed up without advanced neck dissection, advanced therapeutic neck dissection should be performed in patients with positive lymph node.