个体化手术治疗分化型甲状腺峡部癌19例报道

Individualized surgical procedures for well-differentiated thyroid cancer located in the isthmus: report of 19 cases

目的探讨分化型甲状腺峡部癌患者合理的手术方案。方法回顾性分析2013年6月至2018年5月期间于首都医科大学宣武医院普通外科行手术治疗的19例分化型甲状腺峡部癌患者的临床资料。结果19例患者中,15例为单发癌灶且局限于峡部,4例的2个癌灶分别位于峡部和单侧腺叶。1例行峡部扩大切除+喉前和气管前淋巴结清扫术,6例行单侧腺叶切除+峡部切除+患侧中央区淋巴结清扫术,4例行单侧腺叶切除+峡部切除+对侧部分切除+患侧中央区淋巴结清扫术,7例行单侧腺叶全切除+峡部切除+对侧腺叶全/近全切除+双侧中央区淋巴结清扫术,1例行甲状腺全切除+双侧中央区淋巴结清扫+双侧颈部侧区淋巴结选择性清扫术。手术时间为67~313min,中位时间为126min;术中出血量为10~85mL,中位出血量为30mL;住院时间为4~11d,中位时间为6d。术后12例发生低钙血症,无喉上神经及喉返神经损伤发生。19例患者术后均获随访,中位随访时间为26个月(14~69个月)。随访期间,所有患者均未发生永久性甲状旁腺功能低下,无发生颈部淋巴结复发和远处转移患者,无死亡病例,5年无复发生存率为100%,总体生存率为100%。结论针对不同直径及不同前哨淋巴结状态的分化型甲状腺峡部癌患者,应采用个体化的手术治疗方案。

Objective To investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus. Methods Nineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018. Results Among the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy;six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe;four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe;seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides;one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67-313 minutes), the median intraoperative blood loss was 30 mL (10-85 mL), and the median hospital stay was 6 days (4-11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14-69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%. Conclusions For patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.