分化型甲状腺癌45例再次手术临床分析

Analysis of 45 patients with differentiated thyroid carcinoma undergoing reoperation

目的:探讨分化型甲状腺癌再次手术的原因及对策。方法:回顾性分析本科2000年1月～2007年1月收治的甲状腺手术后病理证实为分化型甲状腺癌需再次手术治疗的45例临床病理资料。结果:45例再次手术患者原因为将甲状腺癌误诊为甲状腺良性病变35例(77.7%),首次手术时25例术前未行定性检查,8例病理误诊为良性,首次手术术式选择不当33例(73.3%),术后病理证实癌残留19例(42.2%),术后复发2例(4.4%)。发生短暂喉返神经损伤2例,短暂低钙抽搐2例,发生术后窒息1例,全组无手术死亡。再次手术者术后随访3～7年,平均随访5年,1例手术后34个月死于肺及骨转移,5年生存率为97.77%。结论:甲状腺癌的临床及病理误诊,手术切除范围不够是造成再次手术的主要原因,提高对甲状腺癌的认识水平,强调术前B超+穿刺细胞学检查,常规术中快速冰冻切片,选择正确的手术方式是避免甲状腺癌再次手术的重要环节,熟练掌握再次手术的入路及技巧是确保再次手术成功的关键。

Objective： To explore the cause of reoperation for differentiated thyroid carcinoma and their countermeasures. Methods： The clinicopathologic data were retrospectively analyzed from 45 cases of differentiated thyroid carcinoma confirmed by postoperative pathology undergoing reoperation from January 2000 to January 2007. Results： 45 cases undergoing reoperation, 35 cases （77.7%） were misdiagnosed as thyroid benign lesion in whom 25 cases didn＇t received qualitative examination and the other 8 cases were misdiagnosed as benign lesion by pathology. Of all 45 reoperative cases, 33 cases （73.3%） underwent inappropriate surgery firstly, 19 cases （42.2%） were confirmed as residual carcinoma by postoperative pathology and 2 cases （4.4%） relapsed. Of all 45 cases, 2 cases were in the presence of recurrent laryngeal nerve injury transiently, 2 cases convulsion by hypocalcemia and 1 case postoperative asphyxia. None of all 45 cases were dead. During a follow-up period of 3 to 7 years （mean 5 years）, 1 case died from pulmonary and osseous metastasis 34 months after surgery, with a 5-year survival of 97.77%. Conclusion： The insufficient extent of thyroidectomy resulting from clinicopathologic misdiagnosis of thyroid carcinoma is the major cause of the reoperation. Increased cognitive level of thyroid carcinoma, emphasis on the preoperative mode B ultrasonic inspection plus cytological examination, intra-operative rapid frozen section in routine and appropriate selection of surgical technique may be the important keys to avoidance of reoperation of thyroid carcinoma. And proficiently mastering the surgical approach and technique can be the key to ensuring the successful reoperation.