分化型甲状腺癌的诊治体会

目的:总结分化型甲状腺癌的诊治经验。方法:回顾分析1995年1月至2004年1月期间96例分化型甲状腺癌的诊断和手术冶疗经验。结果:术前确诊52例(72.22%),术中确诊91例(94.40%),术后病理诊断均分化型甲状腺癌,术后随访90例,获得5年以上随访,5年生存率93.75%。结论:甲状腺癌术前常规细针穿刺,术中作冰冻切片,利于术前,术中确诊,并选择正确手术方式,使治疗更合理有效。     

分化型甲状腺癌再手术42例分析

１９８５年１月至１９９５年１０月，４２例分化型甲状腺癌施行了再手术治疗。其中男性７例，女性３５例。再手术原因：原发癌灶残留；术后复发；颈淋巴结转移灶残留；对侧甲状腺及对侧颈淋巴结出现癌灶。再手术方式：原发癌灶局切者应再次切除残叶及峡部；对肿瘤侵出包膜者，作者认为应放宽预防性淋巴结清扫术的指征，有淋巴结转移者施行传统性或功能性颈淋巴结清扫术；对侧腺叶出现癌灶或对侧出现颈淋巴结转移者，应做对侧甲状腺癌的根治手术。     

分化型甲状腺癌再手术42例分析

１９８５年１月至１９９５年１０月，４２例分化型甲状腺癌施行了再手术治疗。其中男性７例，女性３５例。再手术原因；原发癌灶残留；术后复发；对侧甲状腺及对侧颈淋巴结出现癌灶，再手术方式：原发癌灶局切者应再次切除残叶及峡部；对肿瘤侵出包膜者，作者认为应放宽预防性淋巴结清扫术的指征，有淋巴结转移者施行生或功能性颈淋巴结清扫术；对侧腺叶出现癌灶或对侧出现颈淋巴结转移者，应做对侧甲状腺癌根治手术。     

分化型甲状腺癌再次手术临床分析

目的：探讨分化型甲状腺癌再次手术的原因、时机及对策。方法：对5年来收治的甲状腺手术后病理证实为分化型甲状腺癌,需要再次手术治疗的30例临床病理资料进行回顾性分析。结果：24例再次手术的原因为将分化型甲状腺癌误诊为甲状腺良性病变,手术切除范围不够,4例原因为分化型甲状腺癌术后复发,2例原因为131I治疗前的甲状腺清除。结论：分化型甲状腺癌的误诊是造成甲状腺癌再次手术的主要原因,应强调术中快速冰冻病理检查在甲状腺手术中的常规应用。     

分化型甲状腺癌再次手术临床分析

目的:探讨分化型甲状腺癌再次手术的原因、时机及对策。方法:对5年来收治的甲状腺手术后病理证实为分化型甲状腺癌,需要再次手术治疗的30例临床病理资料进行回顾性分析。结果:24例再次手术的原因为将分化型甲状腺癌误诊为甲状腺良性病变,手术切除范围不够,4例原因为分化型甲状腺癌术后复发,2例原因为131I治疗前的甲状腺清除。结论:分化型甲状腺癌的误诊是造成甲状腺癌再次手术的主要原因,应强调术中快速冰冻病理检查在甲状腺手术中的常规应用。     

分化型甲状腺癌再手术治疗

甲状腺癌是常见的头颈部恶性肿瘤。它的发生率占全部恶性肿瘤的1％～4．42％0,分化型甲状腺癌病情进展缓慢,早期诊断、早期治疗,预后良好。但早期治疗不规范,则严重影响患者预后,对于甲状腺二次手术,文献报告亦较少。1990年～2000年期间我科共收治分化型甲状腺癌784例,173例需要再次手术治疗,现总结报告如下。     

分化型甲状腺癌复发再手术36例分析

目的 探讨分化型甲状腺癌术后复发的原因及早期诊断与治疗。方法 分析36例分化型甲状腺癌复发再手术的临床资料，结合献进行讨论。结果 据AJCC临床分期，Ⅰ期12例、Ⅱ期10例、Ⅲ期9例、Ⅳ期5例。乳头状癌22例、滤泡癌10例、髓样癌4例。5年生存率81．3％，10年生存率75．0％。结论 首次术式选择不当，缺碘或放弃甲状腺素激素抑制疗法，是复发的主要原因。滤泡型乳头状癌复发率甚高，占36．1％(13／36)，应引起临床重视。^18F—FDGPET或^99Tcm—MIBI显像检查有助于早期诊断，恰当的手术治疗,可使病人获得再次手术根治的机会。     

影响老年分化型甲状腺癌患者预后的因素分析

目的 探讨影响经甲状腺切除术治疗的老年分化型甲状腺癌患者预后的因素。方法 回顾性分析2015年3月至2018年6月于天津市肿瘤医院行甲状腺切除术的100例老年分化型甲状腺癌患者临床资料,采用Kaplan-meier绘制总生存期(OS)及无病生存期(DFS)曲线,采用Cox风险比例回归模型分析影响OS和DFS的独立预后因素。结果 100例患者中位随访时间为47个月(范围6～60个月)。患者的1、3、5年OS分别为96%、85%、71%,1、3、5年DFS分别为92%、81%、70%。多因素Cox模型分析结果显示:TNM分期和是否行¹³¹I治疗是影响患者OS和DFS的独立预后因素。结论 TNM分期为Ⅲ期和未行碘治疗均会降低患者的远期预后。     

分化型甲状腺癌患者的临床特点及预后分析

目的 分析分化型甲状腺癌患者的临床特点及预后影响因素.方法 收集147例分化型甲状腺癌患者的临床资料,包括一般资料、手术方法、术后基本情况及临床特征,采用Logistic回归模型分析分化型甲状腺癌患者预后的影响因素.结果 147例分化型甲状腺癌患者中,单侧发病95例,双侧发病52例;单发59例,多发88例;91.16％...     

Optimal timing of surgery in well-differentiated thyroid carcinoma detected during pregnancy

BACKGROUND: To determine the optimal timing at which to perform surgery for well-differentiated thyroid carcinoma detected during pregnancy. OBJECTIVES: We retrospectively analyzed 20 cases of women diagnosed during pregnancy with well-differentiated thyroid carcinoma between July 1991 and June 2004, all of whom underwent surgery. The patients were divided into three groups according to the timing of surgery. Group I (n = 9) had thyroidectomy after delivery, Group II (n = 6) had thyroidectomy during the second trimester, and Group III (n = 5) had thyroidectomy after abortion. Group III was excluded from the study because we were interested in determining the optimal timing of surgery in pregnant women. RESULTS: No significant differences were noted between Groups I and II with regard to patient age, tumor size, TNM stage, and the timing of diagnosis. There were no TNM stage changes in Group I, although there was a slight increase in tumor size during pregnancy in this group. Surgical outcome, with regard to type of operation, operation time, perioperative complications, length of hospital stay, and treatment outcome, did not differ significantly between Groups I and II. CONCLUSIONS: In most patients, surgery on well-differentiated thyroid carcinoma detected during pregnancy can be delayed until after delivery.     

Familial well-differentiated thyroid carcinoma

Medical Research Institute of Radiology, Russian Academy Forty-eight cases of familial disease (24 families) (4.3%) were identified among 1,118 patients with well-differentiated thyroid carcinoma who had been either examined or treated at the Clinic of Medical Research Institute of Radiology (1995-2004). In 86% of the study group, papillary thyroid carcinoma (PTC) was associated with tumor of the identical histological pattern while the remaining families revealed association with follicular or medullary thyroid cancer. Carcinoma inheritable from mother was the most frequent (75%). No differences in manifestation, histological pattern, stage or clinical course were established following a detailed evaluation of clinico-morphological data on 43 familial and 172 sporadic (control) cases in both groups. The analysis pointed to a significantly higher incidence of concomitant thyroid pathology in the familial thyroid cancer group. Molecular-genetic study of RET-protooncogene and gene BRAF in 6 blood samples from PTC-bearers established RET-mutation (mother and daughter) in codon 891 (exon 15) G2673A (TCG->TCA). No mutation in BRAF was found.     

Workup of well-differentiated thyroid carcinoma.

BACKGROUND: Well-differentiated thyroid carcinoma (WDTC) includes three main entities: papillary thyroid carcinoma (PTC), follicular thyroid carcinoma (FTC), and Hurthle cell carcinoma (HCC). A thorough knowledge of the natural history and presentation of these carcinomas is vital to the thyroid surgeon. METHODS: This review details the preoperative workup of patients having or suspected to have WDTC. We review the history, physical examination, laboratory, and radiographic evaluations that optimally prepare the surgeon to determine the ideal surgical thyroid and neck treatment for patients with WDTC. RESULTS: A fiberoptic evaluation of the larynx is integral to the physical examination, and a laryngeal assessment is performed for all patients who will undergo thyroid surgery. It must be noted that vocal cord paralysis can be subtle and does not always present with clear dysphagia or voice change. Ultrasound and FNA are the primary tools of preoperative assessment. Given that patients with preoperative FNA positive for papillary cancer are expected to have clinically significant nodal disease in one third of cases, radiographic evaluation must be appropriately aggressive. The combination of US and CT allows assessment of the central and lateral neck nodes and the thyroid's relationship to central neck viscera. CONCLUSIONS: The overriding principle in the surgical treatment of WDTC is that the surgeon recognizes and encompasses all gross disease in the thyroid and neck nodes at first surgery. The extent of thyroidectomy is tailored not only to the patient's risk group and gross operative findings but also to the progress of the specific surgery in terms of parathyroid and recurrent laryngeal nerve preservation.     

Rapidly growing thyroid carcinoma during pregnancy

We experienced two cases of papillary carcinoma of the thyroid during pregnancy. The thyroid carcinomas grew rapidly in early pregnancy. We speculate that human chorionic gonadotropin plays an important role in the rapid growth of thyroid carcinoma during pregnancy. © Wiley-Liss, Inc.     

多功能保留性颈淋巴结清除术

分化型甲状腺癌疗效好，对早、中期的病人多施行功能性颈淋巴结清除术，即保留胸颈乳突肌、颈内静脉和副神经，这就是通常所说的"三保留"手术。作者在长期的工作实践中摸索出其它功能的保留方法并积累了一些经验。自1991年8月至1997年10月共行多功能保留的颈淋巴结清除术105例（3例为双侧颈清术）。除上述三保留以外的保留内容有耳大神经108例次，枕小神经41例次，颈横动脉58例次，颈外静脉10例次和锁骨上皮神经的斜方肌支7例次。术中重点介绍了各功能器官的保留方法和技巧并讨论了耳大神经和枕小神经的功能恢复时间及影响神经功能恢复的因素，为开展此项工作的朋友提供些经验。     

高分化甲状腺癌侵犯上呼吸消化道的治疗

高分化甲状腺癌侵犯上呼吸消化道的治疗对外科医师很具挑战性,在手术切除全部肿瘤同时,应注意保留重要上呼吸消化道结构功能如吞咽呼吸和发声功能,对部分患者可结合^131I和外放射治疗等辅助性治疗,在保证患者的长期生存率的基础上提高生存质量。本文就其生物学特性、诊断、治疗和预后情况作简要综述。     

分化型甲状腺癌侵犯喉气管的外科治疗

目的：探讨分化型甲状腺癌（WDTC）侵犯喉气管的手术治疗方法。方法：回顾性分析21例WDTC侵犯喉气管患者的临床资料。根据手术方式的不同,将患者分为肿瘤根治组（A组,5例）、肿瘤易除组（B组,11例）和姑息性切除组（C组,5例）。结果：21例患者的3,5,7年生存率分别为81．0％（17／21）、61．9％（13／21）和42．9％（9／21）。A、B两组的生存率均明显高于C组（P＜0．001,P＜0．03）,A组的5,7年生存率虽高于B组,但差异无显著性（P＞0．05）。结论：多数WDTC侵犯喉气管患者宜采取保守性手术,如肿瘤侵及管腔内,患者出现呼吸困难和呼吸道出血等并发症,则需要采取根治性手术。     

侵犯喉气管的分化型甲状腺癌治疗分析

目的 评价分化型甲状腺癌侵犯喉气管的治疗效果.方法 分析1992年至2002年在山西省肿瘤医院治疗的分化型甲状腺癌侵犯喉气管的患者42例,全部手术治疗.行肿瘤根治性切除6例,肿瘤切除32例,肿瘤姑息切除4例.部分患者术后补充放射治疗.结果 42例患者中生存5年以上32例,5年生存率76.2%(32/42).结论 尽管分化型甲状腺癌侵犯喉气管治疗困难,但积极手术仍有助于提高疗效和患者生存质量.     

Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cyst

BACKGROUND AND OBJECTIVE: Well-differentiated thyroid carcinoma (WDTC) is diagnosed in approximately 1.5% of thyroglossal duct cysts (TGDC). No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioactive iodine therapy. The current review was undertaken in an attempt to clarify these issues. METHODS: Demographic, clinical, tumor, treatment, pathology, and outcome data on 57 eligible patients reported in recent literature were pooled together with 5 patients treated at our institution for this analysis. RESULTS: A Sistrunk operation was performed for resection of the thyroglossal duct cyst in the majority (90%) of patients. Histologic examination of the tumor in the cyst revealed that papillary carcinoma was the most frequent (92%) histologic type. A total thyroidectomy was performed consequent to the diagnosis of thyroglossal duct cyst carcinoma in approximately half of the 62 patients. A malignant tumor was reported in 27% of the thyroidectomy specimens. Postoperative radioactive iodine therapy was administered in 16 (26%) patients. With a median follow-up of 71 months (range 1-456 months), the 5- and 10-year Kaplan-Meier overall survival was 100 and 95.6%, respectively. There were no disease-related deaths reported in any of the patients. Univariate analysis revealed that the only significant predictor of overall survival was the extent of primary surgery for the thyroglossal cyst. The addition of total thyroidectomy to Sistrunk operation did not have a significant impact on outcome (P = 0.1). Patients treated with postoperative radioactive iodine (RAI) fared significantly worse than those that did not need RAI, which may be explained by the fact that this modality would generally be used in patients with higher risk tumors. CONCLUSIONS: The Sistrunk operation is adequate for most patients with incidentally diagnosed TGDC carcinoma in the presence of a clinically and radiologically normal thyroid gland. Results of adequate excision using the Sistrunk operation are excellent and the concept of risk-groups should be used to identify patients, who would benefit from more aggressive treatment.