546例分化型甲状腺癌手术治疗分析

Operation for differentiated thyroid cancer： a experience of 546 cases

目的探讨分化型甲状腺癌的手术治疗方式。方法回顾性分析2001年1月至2006年12月收治的546例行手术治疗的分化型甲状腺癌患者的临床资料，均行双侧甲状腺全切除术和选择性颈淋巴结清扫术。结果全组无手术及住院期间死亡。颈部淋巴结转移阳性率为76．2％（358／470）。单侧喉返神经损伤的发生率1．1％（6例），双侧喉返神经损伤0例；甲状旁腺部分损伤0．4％（2例），甲状旁腺完全损伤0例；喉上神经损伤0．7％（4例），术后出血0．6％（3例），食管损伤0．2％（1例）。结论对于分化型甲状腺癌患者，均应行双侧甲状腺全切除术；对于肿瘤直径〉1cm的患者，还应行双侧中央组＋患侧颈深组淋巴结清扫。

Objective To approach reasonable operational mode of differentiated thyroid cancer. Methods Retrospectively review 546 differentiated thyroid cancer patients who received bilateral thyroidectomy with or without cervical lymph node excision from January 2001 to December 2006. Results No death case happened during operation and hospitalization. The positive percentage of cervical lymph node metastasis was 76. 2% （358/470）. The incidence rate of single lateral recurrent laryngeal nerve injury was 1.1% （6 cases）, parathyroid gland partly injury was 0. 4% （2 cases）, superior laryngeal nerve injury was 0. 7% （4 cases）, bleeding was 0. 6% （3 cases） and esophagus injury after operation was 0. 2% （ 1 case）. There were no bilateral recurrent laryngeal nerve injury found. Conclusions Total thyroidectomy is an essential operational mode for differentiated thyroid cancer. It is necessary to excise cervical lymph node when the tumor＇s diameter exceeds 1 cm.