221例甲状腺癌的外科治疗体会

Experience in 221 cases of surgical treatment of thyroid cancer

目的探讨甲状腺癌的诊断和外科治疗方法。方法回顾性分析我院2003年1月-2007年12月间收治的221例甲状腺癌患者的临床资料。甲状腺次全切除161例,甲状腺全切57例,姑息性手术3例。除3例行姑息性手术外其余所有患者均常规颈部中心区淋巴清扫。结果术后病理检查证实有淋巴转移者为40.3%(89/221)。术后并发症包括5例短暂喉返神经麻痹,37例短暂低血钙抽搐,1例永久性甲状旁腺功能低下,2例术后颈部血肿。本组患者术前B超检查均发现甲状腺内实性或囊实性低回声结节,其中结节内伴微钙化灶者79例(35.7%)。获得随访187例患者,随访率为84.6%,随访6月-5年,除未分化癌患者术后7月死亡,其余患者均存活。结论患侧甲状腺+峡部+对侧甲状腺大部分切除+中心区淋巴清扫是甲状腺癌的主要手术方式,术前高频B超检查提示甲状腺结节内沙砾微钙化灶对甲状腺癌的术前诊断有重要意义。

Objective To investigate the diagnosis and surgical treatment of thyroid cancer. Methods From January 2003 to Decembher 2007, 221 cases with thyroid cancer were analyzed retrospectively. All cases underwent surgical operations as follows：subtotal thyroidectomy 161 cases, total thyroidectomy 57 cases and palliactive resection 3 cases. Except for 3 cases underwent palliactive operation, the lymph mode dissection of jugular central area was performed routinely in all cases. Results Lymph node metastases were confirmed by postoperative pathological examination in 89 cases （40.3%）. The postoperative complications had 45 cases, including transient recurrent nerve paralysis 5 cases, temporary hypocalcemia 37 hematoma of neck 2 cases. A solid or cystic solid preoperative ultrasonic examination in all cases and with gravel calcified lesion in intra-thyroid nodules. cases, permanent hypoparathyroidism 1 case and nodules of low echo of thyroid were found during among them, 39 cases （35.7%） were associated Follow-up was got in 187 cases. The follow-up time was from 6 months 5 yeras. Except for 1 cases with poorly differentiated cancer died on 7 months after operation, the other patients were still survival. Conclusion Affected lateral thyroid plus isthmus, contralateral subtotal thyroidectomy and lymph node dissection of jugular central area are essential operative manner for the treament thyroid cancer. Preoperative high frequency uhrasonagraphy revealed as gravel calcified lesions has an important value for the preoperative diagnosis of thyroid cancer.