分化型甲状腺癌误诊再手术36例分析

Clinical analysis of reoperation for differentiated thyroid cancer of 36 misdiagnosed cases

目的探讨分化型甲状腺癌误诊的原因、对策以及再次手术的意义、手术方式。方法对36例分化型甲状腺癌患者再手术的临床资料进行回顾性分析。结果本组36例首次手术均误诊为甲状腺良性肿瘤,术后病理检查确诊为乳头状癌29例,滤泡状腺癌7例。再次手术采用患侧腺叶全切、峡部切除加对侧腺叶次全切除术31例,双侧腺叶全切术3例,峡部加双侧腺叶次全切除2例。再手术造成永久性、暂时性喉返神经损伤各1例和3例,甲状旁腺损伤2例。结论术中常规行冰冻切片检查是减少误诊的主要方法。再手术的基本方式为患侧腺叶全切、峡部切除加对侧腺叶次全切除术,常规显露喉返神经、保留甲状腺后包膜是避免损伤的主要措施。

Objective To discuss the cause,strategy of misdiagnosis and significance,mode of the reoperation for differentiated thyroid cancer.Methods The clinical data of 82 cases underwent reoperation for differentiated thyroid cancer were analyzed retrospectively.Results The group of 36 patients was misdiagnosed as thyroid benign tumor before the first surgery,postoperative pathological examination confirmed papillary cancer in 29 cases,follicular cancer in 7 cases.Reoperation with total removal of the affected side lobe,isthmus resection and contralateral subtotal lobectomy in 31 cases,bilateral full-gland resection in 3 cases,the isthmus and bilateral subtotal lobectomy in 2 cases.Reoperation cause permanent,temporary recurrent laryngeal nerve injury in 1 case,3 cases,2 cases of parathyroid injury.Conclusion Routine intraoperative frozen section examination is the main method to reduce misdiagnosis.The basic way of reoperation is the total removal of ipsilateral gland,isthmus resection and subtotal contralateral gland resection,routine exposure of recurrent laryngeal nerve and the maintenance of thyroid rear capsule are the main measures to avoid injury.