分化型甲状腺癌外科治疗的术式选择

目的 :探讨分化型甲状腺癌外科治疗术式的选择。方法 :对 6 6例分化型甲状腺癌病例行患侧腺叶、峡部加对侧次全切除术 49例 ,患侧腺叶及峡部切除术 7例 ,一侧腺叶次全切除及对侧部分切除术 6例 ,全甲状腺切除术 4例。行患侧功能性颈清扫术加对侧功能性颈清扫术 43例 ,双侧功能性颈清扫术 1例及患侧传统性颈清扫术 10例 ,患侧传统性颈清扫术 5例。结果 :3年生存率 96 % (2 5 /2 6 ) ,5年生存率 94% (17/18) ,1例死于白血病 ,1例失访。 4例行全甲状腺切除术的病例术后均出现甲状腺功能减退 ,其中 2例出现甲状旁腺功能减退(5 0 % ) ,其他病例均未发生甲状腺功能和甲状旁腺功能减退。无一例发生喉返神经麻痹。结论 :对分化型甲状腺癌 ,主张行患侧腺叶切除加对侧次全切除或大部切除 ;如术前发现颈淋巴结肿大 ,应同时行患侧淋巴结清扫术。而N0 患者 ,除了对高危组 (男 >41岁 ,女 >5 1岁 )患者腺体外乳头状瘤或明显侵犯包膜的滤泡型腺癌者应行功能性颈清扫术 ,其他随访容易的N0 患者可以不必常规行颈清扫术 ,并提倡长期密切随访。

The selection of surgical technique for differentiated thyroid carcinoma

Objective:To evaluate the optimal extent of primary thyroidectomy and neck dissection in the patiens with differentiated thyroid carcinoma(DTC).Method:Retrospective analysis of 66 cases of DTC. Lobectomy for tumor side plus subtotal lobectomy for another side was performed in 49 cases,lobectomy with isthmusectomy was performed in 7 cases,subtotal lobectomy for one side plus partial lobectomy for another side was perormed in 6 cases ,total thyroidectomy was performed in 4 cases.Unilateral functional neck dissection for another side was performed in 1 case and unilateral traditional neck dissection in 5 cases.Result:The 5 and 3 years survival rates were 94% and 96%. All 4 cases operated with total thyroidectomy suffered hypothyroidism and 2 of them had hypoparathyroidsm postoperatively. There was no hypothyroidism and hypoperthyroidism for other cases. No recurrent nerve paralysis occurred in this group. Conclusion:We recommend lobectomy for tumor side plus subtotal lobectomy for another side for most of DTC. Selective neck dissection is not necessary for N 0 cases unless the patient is in high risk group.