1～4cm分化良好的甲状腺癌选择单侧甲状腺腺叶切除术的效益和风险分析

Analysis of the benefits and risks of 1 to 4 centimetre well- differentiated thyroid carcinoma with lobectomy

目的 研究和分析初次手术选择单侧甲状腺腺叶切除术对1-4 cm甲状腺癌患者带来的效益和风险。方法 系统性回顾郑州大学第一附属医院甲状腺外科在2014年5月-2015年6月间因分化良好的甲状腺癌行甲状腺全切除术的病例，依据最新修订后的美国甲状腺协会（American Thyroid Association, ATA）指南，选取符合行单侧甲状腺腺叶切除术，1-4 cm分化良好的甲状腺癌患者171例，依据原发灶的病理结果特点，评估病例中如果初次手术选择了单侧甲状腺腺叶切除术，则最终可能需要二次行甲状腺全切除术的患者比例。结果 本组患者中，49%面临行二次手术的风险。结论 术前诊断为1-4 cm分化良好的甲状腺癌患者如果行单侧甲状腺腺叶切除术，则面临行二次手术的风险，甲状腺医师及患者在选择手术方式时，应权衡甲状腺全切除术和单侧甲状腺腺叶切除术可能带来的获益和风险。

Objective Study and analyze the benefits and risks of unilateral thyroidectomy for 1 to 4 cm thyroid cancer in primary surgery. Methods The patients who underwent thyroidectomy for 1 to 4 centimeters WDTC （May 2014 to June 2015） were retrospectively reviewed, and the patients with preoperatively known high-risk characteristics were excluded. One hundred and seventy-one patients would have been eligible for lobectomy as the initial operation based on current American Thyroid Association guidelines. The proportion of patients who need secondary surgery was estimated basing on pathological characteristics. Results In this group, 49% patients would have to undergo a secondary surgery if they took lobectomy as the initial operation. Conclusions Patients with 1 to 4 centimeters WDTC who accept unilateral thyroidectomy may take the risk of secondary surgery. Surgeons and patients need to balance the relative benefits and risks of initial TT versus lobectomy before the operation.