颈淋巴结清扫在分化型甲状腺癌再手术中的价值

The value of neck lymph dissection in re-operation for differentiated thyroid carcinoma

目的 探讨颈淋巴结清扫术在分化型甲状腺癌再手术中的价值 ,指导甲状腺癌再手术的术式选择。方法 回顾性分析 12 2例分化型甲状腺癌再次手术病人中 88例作颈淋巴结清扫术的临床资料。 88例中 ,甲状腺肿瘤局部切除术 38例 ,甲状腺腺叶加峡部切除术 16例 ,全甲状腺切除 2例 ,颈淋巴结活检 32例。结果 甲状腺微小癌 11例。颈淋巴结转移率 65 .91% (5 8/88) ,甲状腺残癌率 31.5 9% (12 /38)。结论 颈淋巴结清扫术在甲状腺癌再次手术中具有明确的治疗作用。对侵及包膜、颈淋巴结肿大以及甲状腺微小癌应作颈淋巴结清扫术。对复发癌应再次手术。再手术需彻底切除癌灶 。

Objective To investig the value of neck lymph dissection in re-operation for differentiated thyroid carcinoma (DTC) and direct the choice of re-operative pattern.Method Re-operation was performed in 122 cases with DTC,of which neck lymph dissection was performed in 88 cases and the clinical data were retrospectively analyzed.Of 88 cases,partial thyroidectomy was performed in 38 cases in the first operation,one lobe plus isthmus excision 16 cases,thyroiddectorny was perfomed in 2 cases,neck lymph nodes biopsy in 32 cases.Results 11 patients suffered from thyroid micro carcinoma.The metastasis rate of neck lymph node were 65.91% (58/88) and residual carcinoma rate was 31.59%(12/38). Conclusions Neck lymph dissection had definite curable effect on re-operation for DTC.Neck lymph dissection should be performed when tumor had involved capsule,enlarged lymph node was palpated in the neck and thyroid micro carcinoma was confirmed.Re-operation was necessary for recurrent thyroid carcinoma.Attention must be paid to the fullresection of recurrent lesions and preserving laryngeal nerve and parathyroid in re-operation.