分化型甲状腺癌再次手术治疗分析

Analysis of reoperation with differentiated thyroid cancer

目的探讨分化型甲状腺癌再次手术的原因、必要性和对策。方法回顾性分析我院2000—2010年收治的124例分化型甲状腺癌患者再次手术的临床资料。结果124例甲状腺癌再次手术病例中，75例甲状腺癌误诊为甲状腺良性病变，而行肿瘤局部切除或一侧腺叶次全切除术，手术切除范围不够；39例为首次手术方式选择不当，其中27例已有颈淋巴结转移，未行颈淋巴结清扫术，12例因颈淋巴结转移癌仅行淋巴结活检，忽视甲状腺肿瘤的诊断；10例因为快速病理检查未能诊断甲状腺癌而再次手术。最终病理检查证实肿瘤的残留率为50％（62／124），并发症发生率为4．03％（5／124）。结论甲状腺癌误诊为良性病变是造成再次手术的主要原因；不规范甲状腺癌手术后再次手术是必要的；提高术者对甲状腺癌的认识水平，强调术中快速冰冻切片病检在甲状腺手术中常规应用，选择恰当的手术方式，是避免甲状腺癌再次手术的关键。

Objective To discuss the main causes,necessity and strategy of reoperation in patients with differentiated thyroid cancer. Methods The clinical data of 124 patients with thyroid cancer who needed reoperation from 2000 to 2010 were analyzed retrospectively. Results In the 124 patients with thyroid cancer required for reoperation, 75 cases were misdiagnosed as benign thyroid tumor and previously received local nodulectomy or subtotal lobectomy, in which the extent of resection was not enough;in 39 cases, the first time surgical modality were unsuitable, of which 27 cases with cervical lymph node metastasis were not performed cervical lymph node dissection, and 12 cases with cervical lymph node metastasis cancer were only performed lymph node biopsy, and the diagnosis of thyroid cancer was ignored. 10 cases suffered reoperation because of failure to diagnosis thyroid cancer by quick pathologic diagnosis. The rate of residual cancer was 50% （62/124） by final pathologic diagnosis, and the rate of complication was 4. 03% （5/124）. Conclusion Misdiagnosis of thyroid cancer as benign thyroid tumor is the main cause of reoperation. Reoperation is necessary for those patients who received nonstandardized operation. The key points of avoiding reoperation are to improve cognitive level of operator for thyroid cancer, to emphasize the routine application of quick pathologic diagnosis during operation of thyroid and select the best suitable surgical modality.