分化型甲状腺癌再次手术技巧的探讨

The Reoperative Techniques of Differentiated Thyroid Carcinoma

目的探讨分化型甲状腺癌再次手术的手术方式及手术技巧。方法回顾性分析2011年2月至2013年2月期间解放军总医院普通外科及解放军总医院第一附属医院普通外科收治的56例分化型甲状腺癌再次手术患者的临床资料。结果所有患者均成功完成再次手术，手术时间90～150min，平均120min；术中出血量70～200mL，平均120mL；术后引流量90～210mL，平均100mL。44例患者再次手术后的病理学检查结果与第一次术后病理学检查结果相同，其余12例切除腺体中未见恶性肿瘤组织。所有患者术后均无出血和饮水呛咳发生。术后8例出现手足麻木，5例出现短暂性声音嘶哑。术后50例患者获访，随访率为89．3％（50／56），随访时间为再次手术后6～30个月，平均10．8个月；首次手术后18～66个月，平均45．2个月。随访期间，1例乳头状癌患者死于术后44个月，1例滤泡状癌患者死于术后38个月；3例发生患侧非Ⅵ区淋巴结转移；均无复发。结论对于分化型甲状腺癌患者，再次手术前需要进行全身评估，选择合理的再次手术术式，术中通过使用喉返神经监测、纳米碳标记待清扫淋巴结、保护甲状旁腺等措施，降低再次手术术后并发症的发生率，提高生存率，并改善生活质量。

Objective To explore the reoperative techniques of differentiated thyroid carcinoma. Methods Clinical data of 56 patients who treated in The First Affiliated Hospital of General Hospital of PLA and General Hospital of PLA from Feb. 2011 to Feb. 2013 were analyzed retrospectively. Results All performed surgeries were successful. Surgeries took 90-150 minutes with an average of 120 minutes. Bleeding during surgeries was 70-200 mL with an average of 120 mL. Postoperative drainage was 90-210 mL with an average of 100 mL. The pathological diagnosis of the second surgery in 44 cases were as the same as the first, but there were no malignant tumor tissues of dissected glands in 12 cases. All patients had no postoperative bleeding and bucking, but 8 patients experienced hand and foot numbness, and 5 patients experienced transient hoarseness. Fifty patients were followed-up for 6-30 months （average 10. 8 months） from the reoper- taion and 18-66 months （average 45.2 months） from the first operation, and rate of postoperative followed-up was 89. 3 % （50/56）. During the followed-up, 1 patient with papillary thyroid carcinoma and 1 patient with follicular thyroid carcinoma died in 44 months and 38 months respectively, 3 patients suffered lymph node metastasis at non-VI region of affected side, no one suffered recurrence. Conclusions For differentiated thyroid carcinoma patients who are undergoing the second surgery, thorough whole body condition analysis should be performed and appropriate type of surgery should be chosen. By using recurrent laryngeal nerve monitoring, carbon nanoparticles for lymph node clearance, and protecting parathyroid gland to lower the possibility of postoperative complication, to improve survival rate and life quality.