分化型甲状腺癌的手术范围探讨

Extension of dissection for differentiated thyroid cancer based on frozen-section examination

目的探讨分化型甲状腺癌中央区肿大淋巴结快速冷冻病理检查对手术方案的指导意义。方法回顾性分析206例分化型甲状腺癌患者的临床资料,根据对中央区淋巴结快速冷冻病理的检查结果,分别对甲状腺癌患者行一侧全切+峡部切除或患侧功能性颈淋巴结清扫术。结果全组均行手术治疗,其中甲状腺乳头状癌198例(96.1%),直径<1 cm的微小乳头状癌87例(43.9%),甲状腺滤泡状癌8例(3.9%)。术后随访5年,随访率100.0%,1例在术后3年、2例在术后5年复发而再次手术,其他患者无复发。结论在分化型甲状腺癌患者的手术中,对中央区淋巴结的术中快速冷冻病理检查,可指导对甲状腺癌患者手术方式的选择,减少术后复发。

Objective To evaluate frozen-section examination of central lymph nodes for surgical modality of well- differentiated thyroid cancer. Methods Clinical data of 206 patients with well-differentiated thyroid cancer undergoing thyroidectomy were analyzed. Surgical modalities were chosen as unilateral thyroid resection plus isthmic resection or functional neck dissection according to the results of frozen-section examination of central lymph nodes. Results There were 198 cases of papillary thyroid carcinoma （96.1%）, among which 87 （43.9%） with size 〈 1 cm in diameter, and 8 cases of thyroid follicular carcinoma （ 3.9% ）. All patients were followed up for 5 years. Recurrence occurred in one ease after 3 y and two cases after 5 y. All of them accepted reoperation. Conclusion Frozen-section examination of central lymph nodes is of value for the selection of surgical modalities in thyroidectomy of well-differentiated thyroid cancer.