甲状腺癌累及全甲状腺或双颈转移的处理

The Treatment of Carcinoma inffiltrated to whole Thyroid and Metastasing to both sides of the neck

1980年1月至1990年1月共收治甲状腺癌526例，其中癌肿累及全甲状腺37例，双侧颈部转移42例，（分别占同期7．03％和9．9％），不包括未分化癌，其中，乳头状癌38．1％（16／42），髓样癌23．8％（10／42），滤泡癌14．3％（6／42），混合型23．8％（10／42），37例中15例行一侧腺叶切除，22例行全甲状腺切除；42例中一侧功能性颈淋巴结清除（颈清）5例，双侧功能性颈清13例；一侧治疗性颈清24例；14例发生甲状腺功能低下（37．8％），7例伴不同程度甲状旁腺损伤（18．9％）。

526 cases of carcinoma in the thyroid had been treated in our hospital from Jan. 1980 to Jan. 1990. Among them, 37 cases (7. 03% ) infiltrated to whole thyroid and 42 cases metastasing to both sides of the neck. (undifferentiated carcinoma were not included in. ). In pathology, papillary carcinoma accouted for 38. 1 % (16/42 ), medullary carcinoma 23. 8% (10/42), follicular carcinoma 14. 3 % (6/42), and mixed type 23. 8% (10/42). 37 cases infiltrated to whole thyroid and 42 cases metastased to both sides of the neck. In therapy, 37 cases were treated by whole thyroid excision, 15 cases by single gland lobe plus gorge of the thyroid excision, 42 cases by bilateral neck lymph node dissection. The masses of 3 cases whose tumor had infiltrated to large blood vessels could not be excised completely. 21 cases were operated by tracheotomy and plus radiotherapy after operation. In 14 cases (27% ), the function of the thyroid was lower than usual. 7 cases had parathyroid gland injured. 10 cases (19. 2% ) died of the complication after operation.