分化型甲状腺癌再次手术的原因及对策

目的探讨分化型甲状腺癌再次手术的原因、必要性和对策。方法回顾性分析我院75例分化型甲状腺癌再次手术的病例资料。结果75例甲状腺癌再次手术病例中，61例甲状腺癌误诊为甲状腺良性病变，而行肿瘤局部切除或一侧腺叶次全切除术，手术切除范围不够；12例为首次手术方式选择不当，其中9例已有颈淋巴结转移，未行颈淋巴结清扫术，3例因颈淋巴结转移癌仅行淋巴结活检，忽视甲状腺肿瘤的诊断；2例因为快速病理检查未能诊断甲癌而再次手术。最终病理检查证实肿瘤的残留率为65．33％（49／75）。并发症发生率为6．67％（5／75）。结论甲状腺癌误诊为良性病变是造成再次手术的主要原因；不规范甲状腺癌手术后再次手术是必要的；提高术者对甲状腺癌的认识水平，强调术中快速冰冻切片病检在甲状腺手术中常规应用，选择恰当的手术方式，是避免甲状腺癌再次手术的关键。

Main causes and strategy of reoperation for patients with differentiated thyroid cancer

Objective To study the main causes, necessity and strategy of reoperation for patients with dif- ferentiated thyroid cancer. Methods The clinical data of 75 patients with thyroid cancer which needed reoperation were analyzed retrospectively. Results In 75 patients with thyroid cancer which were required for reoperation,61 cases who had previously been treated with local nodulectomy or subtotal lobectomy in other hospitals were misdiagnosis as benign thyroid tumor, the extent of resection was not enough; 12 cases were unsuitable of the i~rst time surgical modality, among them 9 cases with cervical lymph node metastasis were not performed cervical lymph node dissection. 3 cases with cervical lymph node metastasis cancer were only performed lymph node biopsy, and the diagnosis of thyroid cancer was ignored. 2 cases were suffered reoperation because of fail to diagnosis thyroid cancer by quick pathologic diagnosis. The rate of residual cancer was 65.33% by last pathologic di- agnosis,and the rate of complication was 6.67%. Conclusion Misdiagnosis of thyroid cancer is the main cause of reoperation for these patients. Reoperation is necessary for these patients who received nonstandard operation. The key of avoiding reoperation is to improve cognitive level of operator for thyroid cancer, to emphasize the routine application of quick pathologic diagnosis during operation of thyroid and select the best suitable surgical modality.