再谈分化型甲状腺癌再次手术

Rediscussion of the reoperation of differentiated thyroid cancer

不同地区、同一地区不同诊疗中心对分化型甲状腺癌患者初次手术的治疗观念和规范化程度不同,导致患者的再次手术发生率不同。术者经验、术前评估、手术方式及手术操作都会影响再次手术的成功率。为降低手术风险,减少并发症,应规范处理再次手术,同时结合现有诊疗技术,为再次手术患者提供个体化的治疗方案,在保证疗效的前提下,拓宽手术适应证,变大切口为小切口,变传统开放手术为微创手术,提高患者的生活质量及应对社会压力的信心。本文通过总结分化型甲状腺癌患者再次手术时术前评估主要内容,分析注意事项,为患者合理制定手术方案,以期引起同道重视,规范再次手术治疗,从而实现再次手术的肿瘤R0切除。

The treatment concept and standardization of primary surgery for patients with differentiated thyroid cancer vary among different regions and different treatment centers in the same region,resulting in dfferent reoperation rates for patients.Intraoperative experience,preoperative evaluation,surgical approach,and procedure may all influence the success rate of reoperation.In order to reduce the risk of surgery and complications,reoperation should be treated standardized,while combining the current diagnosis and treatment techniques to provide individualized treatment options for reoperation patients,under the premise of ensuring efficacy,to broaden the indications of surgery,make large incisions into small incisions,and change traditional open surgery into minimally invasive surgery,improve the quality of life of patients and confidence in coping with social stress.This paper will summarize the main content of preoperative assessment at the time of reoperation in patients with dferentiated thyroid cancer,analyze the notes and rationally developing a surgical plan for patients,in the hope of attracting the same emphasis and normalizing the reoperation treatment,so as to achieve reoperation of the tumor RO resection.