82例分化型甲状腺癌再手术临床分析

Clinical analysis of reoperation for differentiated thyroid cancer of 82 cases

目的:探讨分化型甲状腺癌术前诊断,首次手术方式的选择及补充性二次手术的必要性。方法:分析近10年来收治的82例分化型甲状腺癌再手术的临床资料。再手术中采用快速病理检查,根据肿瘤浸润的范围及淋巴结转移情况行甲状腺残叶、峡部、对侧大部分切除,甲状腺全切及同侧淋巴结功能性清扫术。结果:58例行患侧残留腺体峡部及对侧腺体大部分切除,17例行甲状腺全切术。7例因肿瘤侵及范围较广泛仅行姑息性切除。35例因肿瘤侵及甲状腺包膜或术中发现淋巴结肿大,而行同侧功能性淋巴清扫术。术后病理:淋巴结转移22例(62.9%),癌残留52例(63.4%)。再手术造成喉返神经损伤4例,其中3例半年后恢复,1例未见明显改善。甲状旁腺损伤3例,经近期处理后恢复。食管损伤1例。结论:分化型甲状腺癌术前定性诊断较困难,局部切除癌残留率较高,应及时做补充性二次手术。小于一叶切除的手术方式应废止。

Objective： To study the results of the reoperation for thyroid cancer. Methods： The clinical data of 82 cases in our hospital during a period of ten years who underwent reoperation for thyroid cancer were analyzed retrospectively. Results： Excision of the affected lobe,isthmus and greater part of the opposite lobe was performed in 58 cases,total thyroidectomy in 17 cases, excision of palliation in 7 cases that neoplasms infiltrate generally, functional cervical dissection in 7 cases that found lymphadenectasis in intraoperative. Results of postoperative pathology：22 cases （62.9%） had lymph node metastasis,52 cases （63.4%） with residual cancer in thyroid. There were 4 patients with recurrent laryngeal nerve injury included 3 cases recovered half a year later, 3 cases had parathyroid gland injury that recovered in the near future, there were no cases of esophageal injury. Conclusion： Because of the high residual cancer rate of local mass resection for thyroid carcinoma and it is difficult to diagnose before reoperation, reoperation is necessary.The modus operandi of ablate unilateral gland should be abolished.