甲状腺乳头状癌的外科治疗探讨

Surgical treatment of papillary thyroid carcinoma

目的探讨甲状腺乳头状癌(PTC)的外科治疗相关问题。方法对100例PTC手术治疗病例临床资料进行回顾性分析。结果对100例患者中发现124个癌灶,多灶性甲状腺癌17例(占17.0%),颈部淋巴结转移40例(40.0%);合并结节性甲状腺肿﹑桥本病﹑滤泡型腺瘤36例(36.0%)。手术方式包括:甲状腺患侧叶切除术52例,患侧全切加对侧大部分切除术33例,甲状腺全切15例,中央区淋巴清扫术100例,侧颈部淋巴清扫术37例。术后并发症发生率7.0%;术后1例同侧颈淋巴结转移,1例对侧甲状腺出现癌灶。结论应根据PTC患者病变的不同部位及数目(单发/多发)及有无淋巴结转移采用相应的手术方式。

Objective To explore the relative problem of surgical treatments of papillary thyroid carcinoma （PTC）. Methods Clinical data of 100 cases of PTC were analyzed retrospectively. Results Among 100 cases,there were 124 cancers, 17 cases（ 17.0% ） of thyroid cancer with multifocal differentiated carcinomas ;40 cases （40.0%） of metastasis in cervical lymph nodes;and 36 cases（36.0% ） of co-existence of multinodular goiter,Hashimoto disease or follicular adenoma. Various operative procedures were used in the treatment of 100 cases of thyroid microcarcinoma that included excision of the affected lobe in 47 cases, excision of the affected lobe and greater part of the opposite lobe in 33 cases, total thyroideetomy in 15 cases. Central compartment neck dissection 100 cases, bilateral total resection combined with neck dissection. The incidence rate of complications after surgery was 7.0%, 1 case had metastatic cervical lymph nodes at the same side. 1 case had focal cancer at the other side. Conclusion The selection of operative procedure for thyroid microcarcinoma must be determined according to the tumor location of tumor and the number （ single or multiple）.