分化型甲状腺癌局部切除术后再次手术的探讨

目的探讨甲状腺结节初次手术方式的选择,以及分化型甲状腺癌局部切除术后再次手术的必要性。方法回顾性分析4年间收治的138例分化型甲状腺癌局部切除术后行再次手术的患者的临床资料。再次手术均行双侧甲状腺全切加不同范围的颈部淋巴结清扫。结果再次手术后病理检查腺体和淋巴结内有残余癌的发生率为76.8%。院外首次手术后单侧喉返神经损伤的22例及双侧损伤的1例(总发生率为16.7%),经修复后恢复19例。再次手术后新发的喉返神经损伤3例(2.2%),甲状旁腺部分损伤2例(1.4%),喉上神经损伤2例(1.4%);无食管损伤及术后出血。结论分化型甲状腺癌局部切除术后癌残留的发生率较高,应再次手术。再次手术以选择双侧甲状腺全切和颈部淋巴结清扫为宜。

Reoperation after local excision of differentiated thyroid cancer

Objective To study the choice of initial operative approach for thyroid nodule and the necessity of reoperation after local excision of differentiated thyroid cancer.Methods Clinical data of 138 patients with differentiated thyroid cancer after local tumor excision had reoperation at our hospital during a period of four year were retrospectively reviewed.All the reoperations were bilateral thyroidectomy and cervical lymph node excision.Results There were 76.8% patients with residual cancer in thyroid and cervical lymph node.There were 23 patients(16.7%) with recurrent laryngeal nerve injury that included 22 cases with unilateral and 1 case with bilateral injury after the initial operation,and 19 of the 23 patients with recurrent laryngeal nerve injury recovered after nerve repair.After thyroid reoperation,3 cases(2.2%) had recurrent laryngeal nerve injury,2 cases(1.4%) had partial parathyroid gland injury,2 cases(1.4%) had superior laryngeal nerve injury,but there were no cases of esophageal injury or postoperative bleeding.Conclusions The incidence of residual cancer is high after local excision for differentiated thyroid cancer,therefore,reoperation with bilateral thyroidectomy and cervical lymph node excision is necessary.