甲状腺峡部乳头状癌手术切除范围探讨

Discussion of the operative methods for papillary thyroid carcinoma in isthmus

目的探讨甲状腺峡部乳头状癌手术切除的范围。方法回顾性分析上海交通大学医学院附属瑞金医院和远洋分院自2007年1月至2011年12月收治的28例甲状腺峡部乳头状癌的临床资料。结果 28例中20例(71.43%)双侧中央区淋巴结均发现转移,8例(28.57%)双侧中央区淋巴结未发现转移。13例术前伴双侧甲状腺多发结节者,9例结节性甲状腺肿,4例慢性淋巴细胞性甲状腺炎伴结节性甲状腺肿,其中1例发现微小癌。3例术前伴一侧多发结节者,为结节性甲状腺肿。术后有3例出现暂时性声嘶,7例发生暂时性低钙血症。结论甲状腺峡部乳头状癌行双侧中央区淋巴结清扫是必要的;对伴双侧甲状腺多发结节者,同时行甲状腺全切除术;但对仅峡部单发癌结节或一侧腺叶多发结节者,行双侧甲状腺次全切或结节侧腺叶切除及对侧无结节侧腺叶次全切,以减少术后并发症。

Objective To discuss the operative methods for papillary thyroid carcinoma in isthmus. Methods The clinical data of 28 cases of papillary thyroid carcinoma in isthmus treated from January 2007 to December 2011 at Ruijin Hospital and Yuanyang Hospital of Shanghai Jiaotong University School of Medicine were analyzed retrospectively. Results The metastasis of bilateral central lymph nodes was found in 20 of 28 cases（71.43%）. No metastasis of bilateral central lymph nodes was found in 8 of 28 cases（28.57%）. Among 13 cases of preoperative bilateral multiple thyroid nodules, 9 cases had nodular goiter and 4 cases had chronic lymphocytic thyroiditis accompanied with bilateral nodular goiter including 1 case of thyroid microcarcinoma. Three cases of preoperative unilateral multiple nodules had nodular goiter. There were transient vocal hoarseness in 3 cases and transient hypocalcemia in 7 cases. Conclusion Bilateral central lymph node dissection is essential for papillary thyroid carcinoma in isthmus. Total thyroidectomy should be performed for bilateral multiple thyroid nodular. For single nodule in isthmus or multiple nodules in unilateral lobe, bilateral subtotal thyroidectomy or lobectomy in the nodular lobe and the subtotal lobectomy in the normal should be performed to reduce the incidence of postoperative complications.