甲状腺癌再手术85例临床分析

The clinical analysis of 85 cases thyroid gland carcinoma reoperation

目的:探讨甲状腺癌再次手术的原因、手术方式的选择和治疗效果。方法:回顾性分析本院2009年4月至2013年4月收治的复发性甲状腺癌的临床资料,总结甲状腺癌再手术的手术方式及喉返神经、甲状旁腺的探查方法。结果:85例患者中,由于首次手术不当而造成癌组织残留55例,占64.7%。术后病理证实为淋巴结癌转移47例,颈部淋巴结转移率55.3%。永久性喉返神经损伤3例(3.5%),甲状旁腺损伤致低钙血症5例(5.9%)。结论:甲状腺癌术中环甲关节区域癌肿的残留是造成复发的主要原因,再次手术中喉返神经入喉区段的完整解离,规范化颈廓清手术及术后1月的131I治疗是确保其成功的关键。

Objective： To discuss the cause of thyroid gland reoperation,choice of the operation style and operation effect. Methods： The recurrent thyroid gland carcinoma patients clinical data were restrospectively analysed. Results：For 85 cases,the carcinoma tissue residues caused by the improper operation style were 55 cases（ 64. 7%）,the lymph node metastasis confirmed by pathological results were 47 cases,the lymph node metastasis rate was 55. 3%,the eternal recurrent laryngeal nerve injury were 3（ 3. 5%）,parathyroid gland injury were 5（ 5. 9%）. Conclusion：During the operation,the remain carcinoma tissue in cricothyroid joint region is the main cause of the postoperative recurrence,the total dissection of the laryngeal recurrent nerve crico- thyroid joint section,formal neck dissection and postoperative131 I treatment in 1 month are the guarantee for the success of operation.