双侧甲状腺癌外科诊治体会

Diagnosis and surgical treatment of bilateral thyroid carcinoma

目的探讨双侧甲状腺癌的诊断与外科治疗经验。方法回顾分析72例双侧甲状腺癌外科治疗临床资料。结果术后石蜡切片均证实为双侧甲状腺癌,其中双侧微小癌17例,一侧微小癌、一侧非微小癌41例,双侧均非微小癌14例。双侧乳头状癌67例(93.1%),双侧滤泡性癌2例(2.8%),双侧髓样癌2例(2.8%),双侧低分化癌1例(1.4%)。62例行双侧甲状腺全切除术,2例行双侧甲状腺近全切除术,8例行一侧全切加对侧次全切除术,常规行双侧中央组淋巴结清扫。加行一侧改良颈淋巴结清扫术19例。中央组淋巴结转移率33.33%(24/72)。即使双侧甲状腺微小癌灶中央区淋巴结转移率亦有17.65%(3/17)。肿块大小与中央区淋巴转移率有一定相关性,但无统计学意义(P>0.05)。70例随访3个月至8年,中位随访时间5年6个月,67例无瘤生存,另外3例出现颈部淋巴结转移。术后无。例出现永久性甲状旁腺机能减退和喉返神经麻痹。结论双侧甲状腺癌主张行双侧甲状腺腺叶全切除;应重视中央组淋巴结清扫。

Objective To investigate the diagnosis and treatment of bilateral thyroid carcinoma. Methods The clinical records of 72 cases of bilateral thyroid carcinoma from 2000 to 2008 were retrospectively analyzed. Results All cases were confirmed as bilateral thyroid carcinoma by paraffin section post-operatively. They included 17 cases of bilateral micro-carcinoma, 41 cases of one lateral micro-carcinoma and other lateral non-microcareinoma, and 14 cases of non-microcarcinoma. Pathological type was divided into 4 types： papillary careinoma（ 67 cases, 93. 1% ） , follicular carcinoma （2 cases, 2.8% ） , medullary carcinoma （ 2 cases, 2. 8% ） , poorly differentiated carcinoma （ 1 case, 1. 4% ）. Among them, 62 cases were treated with total thyroidectomy, 2 cases with near total thyroidectomy, and 8 cases with a lobectomy and a sub-total thyroidectomy. Central region lymph nodes were resected in all cases, and additional unilateral functional lymph nodes resection was performed in 19 cases. Central region lymph nodes metastasis rate was 33. 33% （24/72） , and for bilateral micro-carcinoma of thyroid it was 17. 65% （3/17）. There was some relationship between central region lymph nodes metastasis rate and cancer diameter, but no significant difference was shown （ P 〉 0. 05 ）. Seventy patients were followed up from 3 months to 8 years post-operatively, with tumor-free survival in 67 cases, and cervical lymph nodes metastasis in 3 cases. No permanent hypo-parathyroidism or paralysis of recurrent laryngeal nerves occurred. Conclusions Total thyroidectomy is advised for bilateral thyroid carcinoma. It is necessary to emphasize the importance of resection of the central region lymph nodes.