T4期分化型甲状腺癌诊治策略及其难点

Strategy and difficulty in diagnosis and treatment of T4 well-differentiated thyroid cancer

T4期分化型甲状腺癌属于晚期甲状腺肿瘤。但其发展缓慢,生物学特性呈"惰性"。因此,其有别于其他晚期恶性肿瘤。如果采取恰当的治疗方法,仍可延长病人生命并改善其生活质量,部分病人甚至可以治愈。因此,明确诊断很重要。对于没有广泛转移的T4期分化型甲状腺癌病人,建议采取积极的手术治疗,包括保守性和根治性手术。保守性手术基本保留了组织器官结构和功能的完整性,但有肿瘤残留风险;根治性手术可以彻底治愈,但存在术后致残可能,且手术并发症发生率较高,影响病人生活质量。对于有广泛转移的T4期分化型甲状腺癌病人,必要时须行姑息性手术,术后辅以综合治疗,也可有效缓解症状和延长存活期。

Although T4 well-differentiated thyroid cancer belongs to advanced turmor, it grows slowly and lazy in nature. So the characteristics of T4 well-differentiated thyroid cancer is different from other advanced turmor. If given the best therapy, patients in T4 well-differentiated thyroid cancer could achieve good outcomes. A positive diagnosis is very important. An active operation is recommended to T4 well-differentiated thyroid cancer without widespread metastasis. The manner of active operation comprised of conservative and radical operation. In conservative operation, the function of organs could be preserved but the tumor could be retained. In radical operation, the tumor could be removed but the quality of patient postoperatively could be poor, and the postoperative complication is higher. The palliative surgical treatment should be performed in T4 well-differentiated thyroid cancer with widespread metastasis for reducing symptom and extending patient＇ s life.