分化型甲状腺癌的外科治疗

Surgical treatment of differentiated thyroid carcinoma

目的总结分化型甲状腺癌的诊治经验。方法回顾110例分化型甲状腺癌的临床资料。结果全组均行手术治疗辅以内分泌治疗，110例分化型甲状腺癌中，病理示乳头状癌88例（80％），滤泡状腺癌22例（20％）。淋巴结转移者22例（20％）。手术方式包括单侧病变行患侧腺叶加峡部及对侧大部切除59例（其中功能性颈清扫12例），患侧腺叶加峡部切除29例（其中功能性颈清扫7例）；双侧病变行一侧腺叶加峡部及对侧大部分切除18例（其中功能性颈清扫5例），甲状腺全切除术加双侧颈清扫2例；1例肺转移患者行甲状腺全切及颈部淋巴结清扫术后行^131I内放射治疗。98例术后随访10年生存率91．8％。结论分化型甲状腺癌预后较佳，治疗关键是正确根据其病情选择合适的手术方式。

Objective To summary the experience in surgical treatment of differentiated thyroid carcinoma （DTC）. Methods The clinical data and follow-up results of 110 cases of DTC were retrospectively analyzed. Results 110 patients received operation and TSH suppress therapy. Histologic examination after operation revealed that papillary thyroid carcinoma（PTC） 88 cases（ 80% ） ,follicular thyroid carcinoma 22 cases（20% ） ,cervical lymph node metastasis were found in 22 cases （20%）. The operation procedure consists of excision of the suffered lobe,isthmus and greater partial of the opposite lobe 59 cases （ along with functional cervical dissection 12 cases ） ; excision of the suffered lobe,isthmus 29 cases （ along with functional cervical dissection 7 cases ） ; excision of the suffered lobe, isthmus greater partial of the opposite lobe t8 cases（ along with functional cervical dissection 5 cases） ;total thyroidectomy and bilateral cervical dissection 2 cases;total thyroidectomy and bilateral cervical dissection with postoperative ^131I therapy, 1 eases with metastasis to lung. 98 cases 10-year survival rate was 91.8%. Conclusion Differentiated thyroid carcinoma has a good prognosis ,a proper surgical procedure is the key point to get a good outcome.