甲状腺乳头状癌再次手术的原因及初步经验

Reasons and Preliminary Experience of Reoperation for Thyroid Papillary Carcinoma

目的:探讨并分析甲状腺乳头状癌(thyroid papillary carcinoma,PTC)再次手术的原因及影响因素,总结初步经验。方法:回顾性分析2014年10月至2019年9月于西南医科大学附属医院甲状腺外科因PTC术后复发而再次手术的42例患者的临床资料,从性别、年龄、复发间隔时间、初次及再次手术方式、淋巴结转移等分析其再次手术的原因。结果:42例再次手术的PTC患者中,男12例,女30例,平均年龄(44±5)岁(范围13~71岁),<55岁者31例,≥55岁者11例,复发时间为术后100日~12年,≤1年内复发21例(50.0%),1~2年(含2年)内复发7例(16.7%),2~5年内复发6例(14.3%),≥5年复发8例(19.0%);县区级及以下医院初治27例(64.3%),地市级及以上医院初治15例(35.7%)。42例PTC术后复发再次手术患者均完成颈部淋巴结清扫。完成中央区淋巴结清扫34例,其中13例(31.0%)仅单纯行中央区淋巴结清扫术;完成颈侧区淋巴结清扫29例,其中19例(45.2%)行中央区淋巴结清扫+患侧颈侧区淋巴结清扫术;存在双侧颈侧区淋巴结转移,5例(11.9%)行中央区淋巴结清扫+双颈侧区淋巴结清扫术;5例(11.9%)行患侧颈侧区淋巴结清扫术。结论:甲状腺乳头状癌复发再次手术可能因为是手术不规范与术中甲状腺腺叶切除范围不足;或是受限于初诊医院水平,对PTC的评估不充分,标准化术式掌握不好,甲状腺手术技巧不熟练等。再次手术时,建议由经验丰富的专科医师完成手术,注意把握手术的时机及术式,术中注意加强保护甲状旁腺及喉返神经。

Objective:To discuss and analyze the causes and influencing factors of thyroid papillary carcinoma(PTC)reoperation,and summarize the preliminary experience.Methods:Clinicopathological data of 42 PTC patients who underwent reoperation in the Department of Thyroid Surgery in the Affiliated Hospital of Southwest Medical University from October 2014 to September 2019 were retrospectively analyzed,and reasons for reoperation such as gender,age,recurrence interval,initial and reoperation methods,and lymph node metastasis were analyzed.Results:Among the 42 PTC patients undergoing reoperation,there were 12 males and 30 females.The mean age was 44±5(13-71)years old,with<55,31 cases younger than 55 and 11 cases older than 55.Time of postoperative recurrence ranged from 100 days to 12 years,including≤1 year in 21 cases(50.0%),1-2 years(including 2 years)in 7 cases(16.7%),2-5 years in 6 cases(14.3%)and≥5 years in 8 cases(19.0%).27 cases(64.3%)were initially treated in hospitals at the county level or below,and 15 cases(35.7%)in hospitals at the prefectural level or above.Cervical lymph node dissection was performed in 42 patients with recurrent PTC.Among the 34 patients who completed central lymph node dissection,13(31.0%)were treated with central lymph node dissection alone.29 patients(45.2%)underwent lateral cervical lymph node dissection,of which 19(45.2%)underwent central lymph node dissection plus lateral cervical lymph node dissection.Bilateral cervical lymph node metastasis was found in 5 patients(11.9%)who underwent central lymph node dissection plus bilateral cervical lymph node dissection.5 cases(11.9%)underwent lymph node dissection in the affected side of the neck.Conclusion:The recurrence of and reoperation for PTC may be due to reasons such as nonstandard initial operation,insufficient scope of intraoperative thyroidectomy,limited level of the initial hospital,inadequate evaluation of PTC,poor mastery of standardized operation,and unskilled thyroid surgery skills etc.For the second operation,experienced specialist are recommended,the timing and mode of the operation should be properly chosen,and parathyroid gland and recurrent laryngeal nerve should be well protected during the operation.