甲状腺乳头状癌射频消融治疗后再手术5例临床分析

Re-operation for papillary thyroid carcinoma after radiofrequency ablation therapy: A clinical analysis of 5 cases

目的总结射频消融治疗（RFA）后甲状腺乳头状癌（PTC）病人再手术的治疗体会。方法回顾性分析中国医科大学附属第一医院甲状腺外科2014年11月至2015年1月收治的5例经外院RFA治疗后病理检查证实为PTC病人的临床资料。结果单发癌3例，多发且双叶癌2例，癌直径0．4～3．0cm，平均1．76cm。行患侧腺叶＋峡部切除＋患侧中央区淋巴结清扫术2例，全甲状腺切除＋患侧中央区淋巴结清扫术1例，全甲状腺切除＋双侧中央区淋巴结清扫1例，全甲状腺切除＋双侧中央区淋巴结清扫＋右侧改良型侧颈区淋巴结清扫1例。术后石蜡病理检查均证实为PTC。中央区淋巴结转移4例，其中颈侧方淋巴结转移1例。术后暂时性甲状旁腺功能低下1例，无其他并发症。结论应规范RFA适应证。RFA治疗后诊断为PTC的病人，应积极手术治疗，由于RFA治疗后局部粘连和水肿较明显，手术应由有经验的外科医师来施行。

Objective To investigate the treatment of papillary thyroid carcinoma （PTC） after radiofrequency ablation （RFA）. Methods The clinical data of 5 cases of PTC after RFA from November 2014 to January 2015 in the Department of Thyroid Surgery, the First Affiliated Hospital of China Medical University were studied retrospectively. Results There were 3 cases of single lesion and 2 cases of multiple lesions in bilateral lobes. The mean tumor size was 1.76 cm （range 0.4 - 3.0 cm）. Two cases received unilateral thyroid lobectomy plus isthmusectomy with ipsilateral central lymph node dissection （CLND）. One case received total thyroidectomy with unilateral CLND. One case received total thyroidectomy with bilateral CLND and 1 case received total thyroidectomy with bilateral CLND and unilateral modified lateral lymph node dissection. All cases were diagnosed as PTC by routine histopathology. There were 4 cases of central lymph node metastasis in which 1 case of lateral lymph node metastasis. There was no complications, but temporary hypoparathyroidism in 1 case. Conclusion The indications for RFA should be grasped strictly. Early operations for PTC after RFA should be performed by an experienced surgeon, given that local tissue adhesion was obvious.