甲状腺癌再手术的方案选择

Reoperation for thyroid cancer

目的分析甲状腺癌再次手术的结果,为规范临床甲状腺癌的治疗提供参考。方法回顾性病例对照研究,288例中男69例,女219例,病理类型:乳头状腺癌249例(86.5%),滤泡状腺癌27例(9.4%),髓样癌6例(2%),未分化癌6例(2%)。再次手术时间:1年以内240例(83%)。手术方式有一侧腺叶(或残叶)及峡部切除和(或)对侧腺叶次全切除加一侧颈淋巴结清扫或双侧颈淋巴结清扫。结果残余腺叶有癌组织残存占63例,对侧腺叶有癌肿33例。原发灶同侧颈淋巴结转移164例。结论对甲状腺癌应慎重选择肿瘤切除或腺叶部分切除,同时应重视颈淋巴结转移状态的评估。

OBJECTIVE To study the results of the reoperation for thyroid cancer. METHODS The clinical data of 288 cases who underwent reoperation for thyroid cancer were analyzed retrospectively. There were 69 male and 219 female. There were 249 cases （86.5 %） with papillary adenocarcinoma, 27 cases （9.4 %） with follicle adenocarcinoma, 6 cases （2 %） with medullar cancer, and 6 cases （2 %） with anaplastic cancer pathologically. The types of operation were Iobectomy and near total lobectomy. The unilateral or bilateral neck dissections were performed in selected cases. RESULTS Pathological examination reveal that there were 63 cases of cancer residual in the ipsilateral side and 33 cases of the opposite side. The cervical node metastasis were present in 164 cases of patients at the same side. CONCLUSION The ipsiiateral side lobaectomy and/or contralateral side near total tobectomy should be employed for the thyroid cancer patients. The neck dissection should be performed in most of the patients.