94例甲状腺癌患者再手术治疗的临床分析

目的:对94例甲状腺癌患者再次手术治疗进行临床分析,为再次手术方式及时机的选择提供理论依据.方法:本探究研究对象为2013年6月至2015年6月再次手术治疗的94例甲状腺癌患者,对94例患者的病历资料进行回顾性分析,并再次行石蜡病理切片诊断,记录患者首次手术方式、首次手术至再次手术时间、再次手术原因以及再次手术方式,并通过2年的随访观察再次手术术后预后情况.结果:首次手术后近期(2~30d)再手术12例,比例12.77%,中期(31d~1年)40例,比例42.55%,晚期(>1年)42例,比例44.68%;再次手术原因为复发及淋巴结转移78例,比例82.98%,首次手术肿瘤残余16例,比例17.02%;再次病理诊断结果为甲状腺乳头癌80例,比例85.11%,髓样癌8例,比例8.51%,滤泡状癌6例,比例6.38%;再次手术方式分别有37例剩余甲状腺全切、33例患侧腺叶加峡部切除、16例患侧腺叶、峡部加对侧大部切除、4例单纯选择性颈淋巴结清扫、4例甲状腺癌根治加全喉切除;术后随访两年,2例因多发性肺部转移死亡,1例局部再次复发因窒息死亡,其余均为无瘤生存.结论:局部复发及淋巴结转移、术后肿瘤残留是甲状腺癌患者再手术治疗的主要原因,病理诊断以甲状腺乳头癌为主,再次手术需根据彩超、CT、FNAC等检查选择适当的手术治疗方式.

Clinical Analysis of Reoperation in 94 Cases of Patients with Thyroid Carcinoma

Objective:To implement clinical analysis of reoperation in 94 cases of patients with thyroidcarcinoma in our hospital,and to provide a theoretical basis for the choice of mode and timing of reoperation. Methods:This study included 94 cases of reoperated patients with thyroid carcinoma in our hospital from June 2013 -June 2015,the medical records of 94 cases were retrospectively analyzed,and paraffin section diagno-sis was taken again,the first operation mode,time of first operation to reoperation,reoperation causes and re-operation mode were recorded, through 2 years of follow up, prognosis after reoperation was observed. Re-sults:There were 12 cases of reoperation at recent period (2~30d) of the first operation,the proportion was 12.77%,mid term (31d~1y) had 40 cases,the proportion was 42.55%,later period (>1y) had 42 cases,the proportion was 44. 68%; There were 78 cases showed causes of reoperation were recurrence and lymph node metastasis,the proportion was 82.98%,residual tumor after first operation had 16 cases,the proportion was 17.02%;The second pathological diagnosis showed thyroid papillary carcinoma of 80 cases,the ratio was 85.11%,8 cases of medullary carcinoma,the ratio was 8.51%,6 cases of follicular carcinoma,the proportion was 6.38%;Reoperation mode were 37 cases of total thyroidectomy, 33 cases of unilateral lobe and isthmus resection,16 cases of unilateral lobe,isthmus,and contralateral subtotal resection,4 cases of simple selective lymph node dissection,4 cases of radical thyroidectomy and total laryngectomy;Two years of follow-up after operation,2 cases of death due to multiple lung metastasis,1 case of partial recurrence death due to suffoca-tion,the rest were tumor-free survival. Conclusion: Partial recurrence, lymph node metastasis, residual tumor after surgery are major causes of reoperations in patients with thyroid carcinoma,pathological diagnosis are mainly thyroid papillary carcinoma,surgery mode of reoperation shall be based on color ultrasound, CT,FNAC examination.