甲状腺癌近期再手术治疗58例临床分析

Clinical Analysis of Recent Reoperation for 58 Cases of Thyroid Cancer

目的:分析甲状腺癌近期再手术的原因及相关因素,讨论再次行甲状腺癌手术的指征及手术方式。方法:回顾性分析重庆医科大学附属第一医院2007年9月至2011年5月收治的58例甲状腺癌患者3个月内再手术的临床资料。58例患者中男性10例,女性48例,年龄介于7岁～75岁,中位年龄40.6岁,所有患者在完善相关检查及病理会诊后二次手术均选择甲状腺全切,并行患侧改良颈清扫或Ⅵ区局域淋巴结清扫。结果:术后病理证实有癌残留36例,残留率为62.07%,其中单纯原发灶残留7例,单纯淋巴结转移13例,原发灶及淋巴结均有残留16例。结论:合理的再手术方式为包括患侧在内的甲状腺全切或近全切,并根据原发病灶情况及病理类型或行选择性局域淋巴结清扫。再手术方式的合理选择可有效减少复发和并发症的发生,为后续I^(131)治疗和血清甲状腺球蛋白监测提供条件,提高病人生存率的同时减少反复多次手术的可能。

Objective： To analyze the reasons and related factors that necessitate the immediate reoperation for recently diag- nosed thyroid cancer patients and to discuss the indications and proper surgical technique for the thyroid cancer reoperation. Methods： Clinical data of 58 patients with thyroid cancer who underwent reoperation within 3 months after receiving the primary surgery for thyroid cancer in the First Affiliated Hospital of Chongqing Medical University from Sep. 2007 to May 2011 were analyzed retrospectively. Ten males and 48 females were involved in this study with the median age of 40.6 years （ ranged from 7 to 75 years）. All patients received reoperation including total thyroidectomy accompanied with ipsilateral modified neck dissection or VI region lymph node dissection after the relevant examination and pathology consultation. Results： Postoperative pathological detection confirmed the existence of residual cancer in 36 cases with the rate of 62.07%. Among these cases, 7 were with the residual of the primary tumor, 13 cases were with pure lymph node metastasis, and 16 cases were with both primary cancer residual and lymph node metastasis. Conclusion： Proper re- operation approaches for thyroid cancer include the ipsilateral total thyroidectomy or subtotal thyroidectomy with selective lymph node dissection which depends on the status of primary lesions and the pathological types of the cancer. The reasonable reoperation approach can be effective in reducing the complications and recurrence of tumor as well as provide the conditions for the following I^131 treatment and serum thyroglobulin monitoring . Reoperation can improve the patient＇ s survival and reduce the possibility of repeated surgery .