分化型甲状腺癌再次手术31例分析

Clinical analysis of 31 cases undergone re-operation for differentiated thyroid carcinoma

目的探讨分化型甲状腺癌(differentiated thyroid carcinoma,DTC)再次手术的原因、指征及操作要点。方法对31例DTC再次手术的临床资料进行回顾性分析。结果再次手术的原因:首次手术误诊为甲状腺良性病变、手术切除范围不够16例;患者要求仅行患侧腺叶切除术、短期内补充性再次手术1例;术后复发或/和颈淋巴结转移14例。再次手术后出现暂时性喉返神经损伤1例,1个月内恢复正常,3例患者出现一过性口唇四肢麻木。结论分化型甲状腺癌术前诊断困难,术前误诊和术后复发或/和颈淋巴结转移是甲状腺癌再次手术的主要原因。再次手术难度大,应尽量完善术前准备,谨慎细致操作,注意保护喉返神经和甲状旁腺以确保手术安全。

Objective To investigate the indications,cause and techniques of the re-operation for differentiated thyroid carci- noma. Methods Clinical data of 31 cases were retrospectively analyzed. Results Sixteen cases were misdiagnosed as benign disease that induced insufficient range of resection operation, one patient required only Ipsilateral thyroid lobectomy that needed re-operation in short time, and 14 cases had postoperative recurrence or metastasis of neck lymph nodes. After re-operation, one case had recurrent la- ryngeal nerve injury that was recovered within one month ; three cases had transient lip or limbs numbness. Conclusion It is not easy to diagnose the disease before operation. Misdiagnosis and postoperative recurrence and/or metastasis of neck lymph node are the major reasons for re-operation. Re-operation is difficult. To ensure safe operation, it needs better preoperative preparation and careful and meticulous operation in order to protect recurrent laryngeal nerve and parathyroid.