甲状腺癌的再次手术治疗

The reoperation of thyroid carcinoma

目的:探讨甲状腺癌再次手术的必要性及其手术方式,分析再次手术的原因。方法:回顾性分析我科于1999年2月～2002年10月,45例甲状腺癌再次手术的临床资料。结果:首次行甲状腺肿块切除术的有43例,行甲状腺患叶+峡部切除术的2例。首次手术后的病理类型:乳头状腺癌32例,滤泡性腺癌12例,髓质样癌1例。根据外院手术治疗资料及我院术前彩色多普勒超声检查或CT检查结果,均再次行手术治疗,其中再次行甲状腺残叶+峡部切除术的28例,行甲状腺残叶+峡部+同侧功能性颈清扫的17例。再次手术后病理检查证实癌残留的29例(67.4％),颈部淋巴结有转移癌的有12例(70.6％),随访至今均生存。结论:甲状腺癌行局部切除术,残癌率高,再次手术是必要的。

Objective: To investigate the necessity and methods of reoperation for thyroid carcinoma and analyzed the causes of reoperation. Methods: A retrospective analysis was made on the clinical data of reoperation in 45 cases of thyroid carcinoma from February 1999 to October 2002. Results: Among the 45 cases, local mass resection performed on 43 patients and one lateral total lobectomy plus isthmus of thyroid on 2 patients. Of them, 32 patients were papillary cancer, 12 were follicular cancer. 1 was medullary cancer. According to the data of other hospitals and examination in our hospital, besides neck color Doppler or CT, all patients were reoperat-ed. Of them, 28 patients with residual lobectomy plus isthmus, 17 patients modified radical thyroidectomy. 29 cases could find out the residual carcinoma at the primary site, 12 cases could find out the lymph nodes metastasis. All the patients survive now. Conclusion: Because of the high residual cancer rate of local mass resection for thyroid carcinoma, reoperation is necessary.