甲状腺全切除术适应证及并发症探讨

Total thyroidectomy： indications and complications

目的 探讨甲状腺全切术手术适应证的选择和并发症防治.方法 回顾2007年4月至2010年6月51例甲状腺全切除术资料.乳头状腺癌48例,滤泡状腺癌1例,髓样癌2例;其中2例合并甲状腺功能亢进,3例合并远处转移.男17例,女34例;年龄5～82岁,中位数50岁;45例为首次手术,6例因复发或转移二次手术.初次手术的45例中T1 17例,T2 13例,T3 7例,T4 8例;NO 31例,N1a 11例,N1b 3例;M1 2例.手术常规解剖甲状旁腺、喉返神经及喉上神经外支,清扫Ⅵ区淋巴组织,其中25例清除Ⅱ～Ⅳ区淋巴组织.8例术后给[3]Ⅰ治疗.结果 随访1～36个月,无死亡病例,2年生存率100.0%（15/15）.病理显示多发癌灶占42.2%（19/45）,颈淋巴转移率51.0%（26/51）.术后永久性甲状旁腺功能低下率为3.9%（2/51）,无永久性喉返神经及喉上神经麻痹.1例髓样癌术后1年对侧颈淋巴结转移,再手术后无复发.初次治疗的2例M1患者远处转移病灶缩小稳定.结论 甲状腺全切除是安全的手术方式,术中解剖喉返神经及甲状旁腺可有效防止并发症的发生.

Objective To investigate the indications and complications of the total thyroidectomy in the management of thyroid cancer. Methods Fifty-one patients with thyroid cancer operated with total thyroidectomy in a period from April 2007 to June 2010, were retrospective analyzed. There were 48 cases of papillary adnocarcinoma, 1 follicular adnocarcinoma, and 2 medullary carcinoma as well, 2 cases with hyperthyroidisms, 3 cases with remote metastasis. There were 17 males and 34 females who in their age ranged from 5 years old to 82 years old with a middle age of 50 years old. Among the 45 cases who were initial surgical management patients, there were 17 T1, 13 T2, 7 T3, 8 T4; and there were 31 NO, 11 N1a,3 N1b, 2 M1. The recurrent laryngeal nerve and the parathyroid gland, and supper laryngeal nerve were exposed routinely. Lymph nodes in Level Ⅵ were dissected in all patients, and Level Ⅱ -Ⅳ dissected in 25patients. 131Ⅰ were administrated in 8 patients. Results Patients were followed up from 1 month to 36months. There were no patients died and lost of follow up. The two years survival rate was 100. 0% （ 15/15 ）Pathological examination showed that the multiple focal disease rate was 42. 2% （ 19/45 ）, the cervical lymph nodes metastases rate was 51.0% （26/51）. There was no permanent paralysis of recurrent laryngeal nerve and outer branch of supper laryngeal nerve. The permanent hypoparathyroidism rate was 3. 9%（2/51）. One case with contralateral lymph node metastasis was reoperated and survived without disease.Two cases with remote metastasis were alive with steadied disease. Conclusions Under the skilled hand,total thyroidectomy is a safe procedure in the management of thyroid cancer. Totally exposing the parathyroid gland and laryngeal nerve is the key point to prevent the major complications.