分化型峡部甲状腺癌的外科治疗:附26例报告

Surgical management of differentiated carcinoma of thyroid isthmus:a report of 26 cases

目的：探讨甲状腺峡部分化型腺癌（DTC）的手术治疗策略。方法：回顾性分析2000年1月—2012年1月手术治疗的26例甲状腺峡部DTC患者临床资料。结果：26例均行甲状腺全切除术及同期双侧颈VI区淋巴结清扫术,16例颈深淋巴结转移者同时行单侧或双侧功能性/根治性颈部淋巴结清扫术。全组无手术死亡,一侧喉上神经损伤1例,一侧喉返神经损伤2例,短暂性甲状旁腺功能减退3例,永久性甲状旁腺功能减退1例。26例均获得1~12年的随访,均健康生存,7例发生颈侧区淋巴结复发转移,再次行单侧颈部淋巴结清扫,并经131I治愈。结论：甲状腺全切除术联合同期双侧颈VI区淋巴结清扫术是甲状腺峡部DTC的有效术式,有颈侧区淋巴结转移时,同时行单侧或双侧功能性/根治性颈部淋巴结清扫术;熟悉解剖、规范精细操作是避免发生严重并发症的关键。

Objective： To investigate the surgical strategies for di erentiated thyroid cancer（DTC） of the isthmus.Methods： e clinical data of 26 patients with isthmus DTC undergoing surgical treatment from January 2000 to January 2012 were retrospectively analyzed.Results： All of the 26 patients underwent total thyroidectomy with synchronous bilateral level VI lymph node dissection,and of them,16 cases with deep cervical lymph nodes involvement received simultaneous uni-or bilateral functional/radical neck dissection.No surgical death occurred in the entire group of patients,unilateral superior laryngeal nerve injury occurred in 1 case,unilateral recurrent laryngeal nerve injury occurred in 2 cases,transient hypoparathyroidism occurred in 3 cases and permanent hypoparathyroidism occurred in 1 case.All of the 26 patients were followed up for one year to 12 years,and all were alive.Amongthem,7 cases developed lateral neck recurrence and metastasis,and were treated by a second radical neck dissection plus 131 I ablation.Conclusion： Total thyroidectomy with synchronous bilateral level VI lymph node dissection is an efective procedure for isthmus DTC,and functional/radical neck dissection should be done when the lateral neck node is involved.Anatomic familiarity and meticulous standardized operation are essentials for avoiding serious complications.