外科治疗晚期分化型甲状腺癌54例临床分析

Clinical analysis of surgical management of 54 patients with late-phase differentiated thyroid carcinoma

目的：回顾性总结外科治疗晚期分化型甲状腺癌的临床经验并讨论其意义.方法：1990/2007普外科行外科手术治疗晚期分化型甲状腺癌54例,男25例,女29例,年龄20～73（平均55.2）岁.结果：肿瘤位于右叶22例,左叶20例,双侧均有12例,肿瘤最小约3.5cm×2.5cm×2.5cm,最大约15cm×11cm×10cm;54例均有不同程度的淋巴结转移,包括淋巴结融合成块16例,癌肿浸润颈前舌骨下肌群及胸锁乳突肌16例,浸润气管15例,浸润食管8例,浸润喉返神经11例和肺转移4例.病理类型：乳头状腺癌36例,滤泡状腺癌15例,髓样癌3例.行甲状腺全切15例,甲状腺次全切39例,患侧根治性颈清扫加对侧功能性颈部清扫18例,双侧功能性颈部清扫36例,无手术死亡病例,术后辅助放射治疗和内分泌治疗.随访5 a生存率80.0%（32/40）,10a生存率72.0%（18/25）.结论：对晚期分化型甲状腺癌患者进行积极手术治疗,术后辅助放射治疗和内分泌治疗可获得良好疗效.

AIM： To summarize retrospectively the clinical experience and discuss the significance in surgical management of late-phase differentiated thyroid carcinoma. METHODS： Fiftyfour patients with late-phase differentiated thyroid carcinoma undergoing surgical management between 1990 and 2007 in the Department of General Surgery of our hospital were enrolled. The gender distribution was 25 male patients and 29 female ones. The average age was 55.2 years （ range： 20-73 years）. RESULTS： The primary tumor located in right lobe in 22 cases, in left lobe in 20 cases and in bilateral lobes in 12 cases. The minimal size of tumor was 3.5 cm × 2.5 cm × 2. 5 cm and the maximal size 15 cm × 11 cm × 10 cm. All the 54 cases had lymph node metastasis with different degree, 16 cases of which had fused lymph nodes. The sites of metastasis included the group of supra-hyoid muscle and sternocleidomastoid in 16, the trachea in 15, the esophagus in 8, the recurrent laryngeal nerve in 11 and the lung in 4. Tumor pathological type was papillary adenocarcinoma in 36, follicular adenocarcinoma in 15 and medullary carcinoma in 3. Fifteen patients underwent total thyroidectomy, 39 cases subtotal thyroidectomy, 18 cases radical neck dissection for tumor side and functional neck dissection for another side and 36 cases bilateral functional neck dissection. There was no postoperative death. All the patients were treated with postoperative adjunctive radiotherapy and endocrine therapy. The 5-year and 10-year survival rates were 80.0% （32/40） and 72.0% （ 18/25 ）, respectively. CONCLUSION： Active surgical management and postoperative adjunctive radiotherapy and endocrine therapy are effective in treating patients with late-phase differentiated thyroid carcinoma.