甲状腺癌的再次手术治疗

目的 探讨甲状腺癌再次手术的意义、手术时机及其手术方式。方法 回顾性分析1989年1月－2000年1月间57例甲状腺癌再次手术的临床资料。结果 首次手术方式为甲状腺肿块切除或甲状腺患叶次全切除术47例，甲状腺癌改良根治术6例，甲状腺患侧叶全切除术4例。首次手术病理类型：乳头癌32例，滤泡状癌15例，混合癌7例，未分化癌3例；再次手术的主要原因为首次手术不当致癌残存和肿瘤复发者47例，占82．5％，其次为术中漏诊6例，快速冰冻切片误诊4例。再次手术中甲状腺及周围组织中残癌率为53．7％；颈部淋巴结残癌率48．6％。再次手术后的5年生存率为92．9％，10年生存率为87．5％。结论 由于甲状腺癌的术前误诊，如首次术式选择不当，则手术后的残癌率较高，再次手术是必要的，而且两次手术间隔不要超过3个月。再次手术时宜重视选择适当手术方式，以提高病人的长期生存率。

Reoperation of thyroid carcinoma

Objective To study the significance,the timing and operative procedure of reoperation for thyroid carcinoma. Methods A retrospective analysis was made on the clinical data of reoperation in 57 cases of thyroid carcinoma form January 1989 to January 2000. Results Among the 57 patients, the original operation including local mass resetion or partial lobectomy of thyroid was performed on 47patients,modified radical thyroidectomy on 6 patients and one lateral total lobectomy of thyroid on 4 patients. Of them, 32 patients were papillary cancer, 15 follicular cancer, 7 mixed papillary-follicular cancer and 3 undifferenticated cancer. The main cause of reoperation was the incorrect first operative procedures, which led to the cancer remnant left and or cancer relapse, in 47 cases (82.5%); the next were due to misdiagnosis (6 cases) during operation and/or in frozen section (4 cases), The incidence of residual cancer in thyroid and its surroundig tissue was 53.7%,and in cervical lymph node was 48.6% in reperation. Survival rate of five-year and ten-year of reoperation were 92.9% and 87.5%, respectively. Conclusions The incidence of residual cancer is high because of erroneous diagnosis before the operation, which may lead to wrong choice of the first operative procedure, which is of necessity for surgical reintervention, and the interval should not be over 3 months. Meanwhile, the choice procedure of reoperation should be emphasized to increase the long-term survival rate after reoperation.