双侧甲状腺乳头状癌手术治疗方法的探讨

Explore surgical management of bilateral thyroid papillary carcinoma

目的 探讨双侧甲状腺乳头状癌的手术治疗方法.方法 回顾性分析55例双侧甲状腺乳头状癌患者的临床资料.行双侧甲状腺全切除术52例,行一侧腺叶全切除＋对侧近全切除术3例.结果 双侧功能性颈淋巴结清扫术中,5例均见双侧颈淋巴结转移,阳性率为100.0%（5/5）;单侧功能性颈淋巴结清扫术中,9例见颈淋巴结转移,阳性率为81.8%（9/11）.双侧中央区淋巴结清扫术中,1例见中央区淋巴结转移,阳性率为25.0%（1/4）;单侧中央区淋巴结清扫术中,14例见中央区淋巴结转移,阳性率为66.7%（14/21）.术后随访0.5～12.9年,53例无瘤生存,2例伴远处转移者也取得良好效果.结论 双侧甲状腺乳头状癌为多发癌,宜行双侧甲状腺全切除术.应结合患者的肿瘤分期,考虑是否行颈淋巴结清扫术.

Objective To explore surgical management of bilateral thyroid papillary carcinoma. Methods The clinical data of 55 patients with bilateral thyroid papillary carcinoma were analyzed retrospectively. Among the 55 patients, total thyroidectomy was performed in 52 cases, total affected lobectomy plus isthmus and opposite near total lobectomy thyroidectomy was performed in 3 cases. Results Among the cases of bilateral functional neck lymph node dissection ,5 cases were all of bilateral neck lymph node metastasis, the positive rate was 100.0%（5/5）;, among the cases of unilateral functional neck lymph node dissection,9 cases were found neck lymph node metastasis,the positive rate was 81.8%（9/11）; among the cases of bilateral central region lymph node dissection, 1 case was of central region lymph node metastasis, the positive rate was 25.0% （1/4）; among the cases of unilateral central region lymph node dissection, 14 cases were of central region lymph node metastasis, the positive rate was 66.7%（14/21）. Fifty-three cases were tumor free survival, 2 cases accompanied distant metastasis also gained good effect Conclusions Total thyroidectomy should be performed for bilateral thyroid papillary carcinoma because of its characteristics of multiple tumors. It is considered that whether the neck lymph node dissection should be done depends on the stage of the tumor.