手术治疗分化型甲状腺癌190例回顾性分析

Restrospective Analysis of Surgical Treatment of 190 Cases with Differentiated Thyroid Carcinoma

目的：通过190例分化型甲状腺癌手术治疗回顾性分析，旨在探讨分化型甲状腺癌的手术切除范围及颈部淋巴结清扫回顾。方法：选取1980年1月至1996年12月收治190例经手术、病理证实为分化型甲状腺癌，其中长期随访140例。结果：156例限于一侧腺叶内的肿瘤，行甲状腺腺叶、峡部切除术，随访102例，仅1例对侧腺叶出现癌复发。96例肿物直径大于1．5cm，并且颈部淋巴结无肿大者，行预防性颈淋巴结清扫，54例发现颈部淋巴结有转移灶。结论：为了降低复发率和避免并发症，甲状腺腺叶、峡部切除是理想的术式；对于原发肿瘤直径大于1．5cm，无论术前、术中是否触到肿大淋巴结，均需作改良颈淋巴结清扫；对临床颈淋巴结阳性者，应根据具体情况实施功能或传统颈淋巴结清扫术。

Objective: The extent of resesction and neck lymph node dissection of differentiated thyroid carcinoma were studied in this paper. Method: 190 cases of thyroid cancer were operated from Jan. 1980 to Dec.1996. All of them were proved pathologically. Results: Excision of one lobe and isthmus were taken in 156 cases. of mhich the primary tumours were within a lobe- 102 cases were follow - up in which ouly one recurred at contralatend lobe. The diameler of tumours were over 1. 5 cm in 96 cases, without palpable neck lymph nodes before operation. Afer modified meck lymph node dissection, cervical lymph node metastaseswas proved in 54 cases by postoperative pathology. Conclusion: To minimize the risk of local recurrence with avoidance of incerease in the complication rate, the excision of thyroid lobe and isthmus is the ideal surgical operation. Modified neck lymph node dissection should be performed, if the diameter of primary tumour is over 1. 5 cm, no matter the lymph node is palpable or not.