分化型甲状腺癌225例诊治体会

目的 :探讨甲状腺分化型癌的诊治。方法 :总结 2 2 5例甲状腺分化型癌的临床资料 ,对原发灶行根治切除 ,第一次手术不彻底者行二次手术。对颈淋巴结阳性 (N )患者行颈清扫术 ,颈淋巴结阴性 (N0 )患者当出现颈淋巴结转移时再行治疗性颈清扫术。结果 :颈部N 患者的 5 ,10年生存率分别为 80 .2 %和 77.1% ,颈部N0 患者随访中出现颈淋巴结转移行清扫术后 5 ,10年生存率分别为 85 .2 %和 80 .4% ,差异无显著性。结论 :B超、CT对诊断分化型甲状腺癌及发现颈淋巴结有否肿大是有效的手段。细针穿刺细胞学检查及术中冰冻病理学检查是明确诊断的主要方法。对分化型甲状腺癌颈部N 患者行治疗性颈清扫 ,提倡功能性颈清扫 ,颈部N0 患者不主张选择性颈清扫术。

DIAGNOSIS AND TREATMENT OF DIFFERENTIATED THYROID CARCINOMA- REPORT OF 225 CASES

Objective:To study the best methods of diagnosis and treatment for the differentiated thyroid carcinoma.Methods:Clinical data of two hundred and twenty five cases from 1980 to 1999 were studied.Lymphadenectomy were performed at the first operation for the cases of lymph node metastasis (N_1),whereas the original lesions were resected and then consulted regularly for those without neck lymph nodes metastasis (N_0),and lymphadenectomy were conducted if tumor recurred.Results:The 5-year-survival-rate and 10-year-survival-rate of N_1 cases were 80.2% and 77.1% respectively,and 85.2% and 80.4% for the N_0 cases with reoperations for the recurred lesions.There was no statistical difference of survival rate.Conclusions:Ultrasound and CT are the valuable diagnosis methods for the detection of lymph node metastasis,and fine-needle aspiration and high-speed pathological diagnosis during operation are very useful for pathological diagnosis.Function-preserved lymphadenectomy is recommended for the patients with lymph node metastasis (N_0),whereas lymphadenectomy is retained for the recurrence of N_0 cases.