甲状腺乳头状腺癌551例外科治疗远期疗效观察

1952～1980年间共手术治疗甲状腺乳头状癌551例,按手术术式将全部病例分为腺叶切除术组及腺叶合并颈淋巴结清除术组。前组中包膜内型(64例)、腺内型(62例)及腺外型(54例)的10年以上无瘤生存率分别为100％、78.57％及47.05％;后组中合并选择性颈清术(193例)及治疗性颈清术(178例)的10年以上无瘤生存率分别为94.70％及67.87％。作者建议,如原发癌为包膜内型,可仅作腺叶切除术;如临床触及颈淋巴结肿大且考虑为转移,或原发癌已侵出肿瘤包膜时,应作腺叶合并颈淋巴结清除术(在不影响彻底切除的情况下尽可能采用功能性颈清术),因侵出包膜的原发癌,腺内型及腺外型病变的颈淋巴结转移率分别为69.53％及76.92％。

A Longterm Observation of 551 Cases with Thyroid Papillary Carcinoma after Surgery

Five hundreds and fifty one patients with papillary carcinoma of the thyroid were treated surgically during 1952-1980. The patients are divided into two groups in terms of the operative procedure used. In the lobectomy group, the 10-year survival rate for intracapsular lesion was 100% and the rates for intraglandular and extra- glandular lesions are 78.57% and 47.05% respectively. In the combined radical resec- tion group, the 10-year survival rate was 94.70%with elective neck dissection and 67.87% with therapeutic neck dissection (P<0.001). The authors suggest that lobecto- my of the involved thyroid lobe is proved to be adequate. When metastasis had de- veloped in the lateral cervical region, a functional or conventional neck dissection should be performed. With no palpable enlarged nodes, the management varied with the degree of extension of the primary lesion. A neck dissection is unnecessary in cases when the lesion is intracapsular, as the frequency of nodal metastasis was only 7.81%. A functional neck dissection appears to be appropriate in the lesions of extracapsu- lar, as the nodal metastasis occurred in the intrathyroid and extrathyroid lesions were 69.53% and 76. 92% respectively.