分化型峡部甲状腺癌的外科治疗：附26例报告

目的:探讨甲状腺峡部分化型腺癌(DTC)的手术治疗策略.方法:回顾性分析2000年1月-2012年1月手术治疗的26例甲状腺峡部DTC患者临床资料.结果:26例均行甲状腺全切除术及同期双侧颈Ⅵ区淋巴结清扫术,16例颈深淋巴结转移者同时行单侧或双侧功能性/根治性颈部淋巴结清扫术.全组无手术死亡,一侧喉上神经损伤1例,一侧喉返神经损伤2例,短暂性甲状旁腺功能减退3例,永久性甲状旁腺功能减退1例.26例均获得1～12年的随访,均健康生存,7例发生颈侧区淋巴结复发转移,再次行单侧颈部淋巴结清扫,并经131I治愈.结论:甲状腺全切除术联合同期双侧颈Ⅵ区淋巴结清扫术是甲状腺峡部DTC的有效术式,有颈侧区淋巴结转移时,同时行单侧或双侧功能性/根治性颈部淋巴结清扫术；熟悉解剖、规范精细操作是避免发生严重并发症的关键.

Surgical management of differentiated carcinoma of thyroid isthmus: a report of 26 cases

Objective: To investigate the surgical strategies for differentiated thyroid cancer (DTC) of the isthmus. Methods: The clinical data of 26 patients with isthmus DTC undergoing surgical treatment from January 2000 to January 2012 were retrospectively analyzed. Results: All of the 26 patients underwent total thyroidectomy with synchronous bilateral level VI lymph node dissection, and of them, 16 cases with deep cervical lymph nodes involvement received simultaneous uni- or bilateral functional/radical neck dissection. No surgical death occurred in the entire group of patients, unilateral superior laryngeal nerve injury occurred in 1 case, unilateral recurrent laryngeal nerve injury occurred in 2 cases, transient hypoparathyroidism occurred in 3 cases and permanent hypoparathyroidism occurred in 1 case. All of the 26 patients were followed up for one year to 12 years, and all were alive. Among them, 7 cases developed lateral neck recurrence and metastasis, and were treated by a second radical neck dissection plus 131I ablation. Conclusion: Total thyroidectomy with synchronous bilateral level VI lymph node dissection is an effective procedure for isthmus DTC, and functional/radical neck dissection should be done when the lateral neck node is involved. Anatomic familiarity and meticulous standardized operation are essentials for avoiding serious complications.