分化型甲状腺癌再次手术的临床分析

Clinical analysis of reoperation for differentiated thyroid carcinoma

目的分析行再次手术的104例分化型甲状腺癌(DTC)的手术方式、病理结果及疗效,探讨DTC再次手术策略。方法回顾性分析104例分化型甲状腺癌患者再次手术治疗的临床资料。结果经病理证实,甲状腺组织总残癌率66.35%,淋巴结残癌率77.89%。患者年龄<45岁、既往颈部淋巴结肿大、原发癌灶残留或复发、原发癌的多发与颈部淋巴结转移显著相关,差异有统计学意义(P<0.05)。术后暂时性喉返神经损伤发生率为2.88%,暂时性低钙血症发生率为5.77%,无永久性喉返神经损伤及甲状旁腺损伤。结论 DTC行再次手术时应保证肿瘤切除的彻底性,尤其对颈部淋巴结的处理;同时尽量防止喉返神经和甲状旁腺损伤等并发症的发生。

Objective To analyze the surgical methods,pathological results and therapeutic effect of 104 cases of differentiated thyroid carcinoma( DTC),and to investigate the reoperation strategy. Methods The clinical data of 104 cases of differentiated thyroid carcinoma treated by reoperation were retrospectively analyzed. Results The total residual cancer rate of thyroid tissues was 66. 35%,and the rate of lymph node residual cancer was 77. 89%. Univariate analysis showed that the patients were aged < 45 years old,had a swollen past neck lymph nodes,residual or recurrence of primary cancer foci,and multiple cervical lymph node metastasis were significantly associated with the primary cancer( P < 0. 05). Incidence of postoperative temporary larynx return nerve injury was 2. 88%,temporary hypocalcemia occur rate was 5. 77%,and there was no permanent laryngeal recurrent nerve injury and parathyroid injury. Conclusion DTC should guarantee the tumor resection thoroughly,especially for the treatment of cervical lymph nodes,and meanwhile complications such as recurrent laryngeal nerve and parathyroid injury should be prevented.