甲状腺癌首次手术不规范原因及再手术情况的调查分析(附298例报告)

Investigation and analysis of the causes of irregularities in the first-time non-standard operation and reoperation for thyroid cancer(298 cases)

目的:调查并分析甲状腺癌(thyroid carcinoma,TC)首次手术不规范的原因,探讨再次手术方式、手术时机及提高无瘤生存率(disease-free survival,DFS)的方法。方法:收集四家二级以上医院收治因首次手术不规范需要再次手术的TC患者298例,分析产生的原因和不良后果。结果:首次手术中没有快速病理诊断114例,占比38.26%。首次手术前或手术中已经发现对侧有结节,因技术原因而未做处理的有7例,占比2.35%;双侧多发病灶或有隐匿性病灶首次手术未发现175例,占比58.72%;有2~5气管软骨环侵犯又能进行切除因条件所限未做气管切除双侧均有病灶的2例,占比0.67%;总计184例,占比61.74%。首次手术颈部淋巴结均未做处理,再次手术术前、术后经检查证实有Ⅵ和/或Ⅲ、Ⅳ、Ⅴ、Ⅱ淋巴结转移,再次行颈部淋巴结清扫术161例,占54.03%;首次手术发生喉返神经损伤11例,再次手术修复3例,占比1.01%。结论:首次手术规范与否,是减少再次手术、提高TC治愈率的关键;TC双侧、多发或隐匿性病灶的比例较高,应引起手术者的重视;TC的颈部淋巴结转移率较高,需要在首次手术中进行Ⅵ和/或Ⅲ、Ⅳ、Ⅱ、Ⅴ淋巴结清扫;再次手术的并发症发生率明显增高,应尽可能一次完成或请有经验的专家术中会诊。

Objective:To investigate and analyze the causes of non-standard surgery for thyroid cancer,and to explore the methods of reoperation,timing of surgery and improvement of disease-free survival(DFS).Methods:A total of 298 patients with thyroid cancer(TC)who were required to undergo reoperation because of the first non-standard surgery in four above second-grade hospitals were analyzed.The causes and adverse consequences were analyzed.Results:The first operation of the primary surgery was improperly treated.There were no rapid pathological diagnosis in 114 cases,accounting for 38.26%,the contralateral nodules were found before the first operation or during surgery,and 7 were not treated for technical reasons,the proportion was 2.35%.175 cases were not found in the first operation of bilateral multiple lesions or occult lesions,accounting for 58.72%.There were 2 cases(0.67%)with 2~5 trachea cartilage ring encroachment and could be excision without bilateral resection due to linited conditions.A total of 184 cases were reported accounting for 61.74%.161 cervical lymph nodes cases was not treated with in the first operation,after reoperation,VI and/orⅢ,Ⅳ,ⅡandⅤlymph node metastasis were confirmed,accounting for 54.03%.In the first operation we found that 2 cases with the cancer infiltrating the trachea,tumor resection were performed for technical reasons,accounting for 0.67%.In the first operation,11 cases of laryngeal nerve injury occurred,and 3 cases required surgical repair,accounting for 1.01%.Conclusion:The first surgery method is the key procedure to reduce the reoperation rate and improve the survival data of TC.The proportion of bilateral,multiple or occult lesions in TC is high,which should be paid enough attention by the surgeon.The cervical lymph node metastasis rate of TC is higher,VI and/orⅢ,Ⅳ,Ⅱ,Ⅴlymph node dissection should be performed during the first operation.The incidence of complications of reoperation was significantly increased,so we should be complete the surgery at once or an experienced expert should be consulted during surgery.