甲状腺乳头状癌108例外科治疗分析

Analysis of 108 Surgical Cases with Thyroid Papillary Carcinoma

目的探索甲状腺乳头状癌外科手术治疗的方法。方法搜集2004年1月-2010年10黄山市人民医院外科诊治108例甲状腺乳头状癌临床资料,对手术方式、效果进行分析。甲状腺患叶切除+峡部切除76例,患叶甲状腺切除+峡部全切+对侧大部分切除22例,双侧甲状腺全切除6例,均行中央区淋巴结清扫,14例有侧淋巴结转移的行功能性淋巴结清扫,患叶甲状腺全切除+峡部全切+双侧功能性淋巴结清扫2例,姑息手术2例。结果术后低钙血症3例为2.7%,喉返神经永久性损伤2例为1.8%,暂时性声音嘶哑3例为2.7%,侧颈部淋巴结转移8例为7.4%,中央区淋巴结转移58例为53%,术后随访1个月～6年,无死亡病例,未发生远处转移。结论甲状腺乳头状癌手术方式应根据病变的部位、大小、淋巴结转移情况行个体化的治疗,术中正确辨认喉返神经可减少喉返神经损伤。

Objective To explore thyroid papillary carcinoma surgical methods. Methods Clinical data of 108 patients with thyroid papillary carcinoma who were admitted into our hospital from January 2004 to October 2010 were ollected, the treating methods and the related outcomes were analyzed. Results There were 76 cases had thyroid lobectomy and resection of isthmus operation ;22 cases had thyroid lobe resection, isthmus total resection and contralateral subtotal operation ;6 cases had bilateral total thyroidectomy operation, with central lymph nodes dissection performed ; 14 cases had functional lymph node dissection on the lateral migrated lymph node;2 cases had the thyroid lobe resection, isthmus total resection and bilateral functional lymph node dissection performed;and 2 cases of palliative surgery. There were 3 cases of postoperative hypocalcemia, occupying 2.7% of the total cases ;there were 2 cases of permanent recurrent laryngeal nerve injury, occupying 1.8% ; there were 3 cases of temporary hoarseness, occupying 2.7% ;there were 8 cases of lateral neck lymph node metastasis, occupying 7.4% and 58 cases of central lymph node metastasis, accounting for 53%. Furthermore, no death cases and distant metastasis cases were found in these groups for one month to six years＇ s following up. Conclusion Thyroid papillary carcinoma surgical methods should be individualized according to the lesion location, size and condition. Proper identification of the recurrent laryngeal nerve during the operation could reduce the nerve injury.