222例分化型甲状腺癌再手术的临床分析

目的 分析分化型甲状腺癌（DTC）再手术的原因，总结减少再次手术的策略。方法 回顾性分析2013年1月至2017年12月于重庆医科大学附属第一医院内分泌乳腺外科行手术治疗分化型甲状腺癌再次手术的患者222例，根据其初次手术前的临床评估情况，将患者分为cN0分化型甲状腺癌（DTC cN0）、cN1分化型甲状腺癌（DTC cN1）、分化型甲状腺癌未评估（DTC unknown）及甲状腺良性病变组，随访统计其再次手术间隔时间、初次手术方式及再次手术区域，分析总结其再次手术的原因及对策。结果 222例中甲状腺乳头状癌（PTC）219例，滤泡状癌（FTC）3例；首次手术术前或术中评估为DTC cN0 63例（284%），DTC cN148例（216%），DTC unknown27例（122%），甲状腺良性肿瘤组84例（378%）。首次手术为良性肿瘤组再次手术均在1年内，DTC cN0组为13个月（15天～132个月），DTC cN1为12个月（4～18个月）。在DTC cN0组中初次手术方式为甲状腺全切+患侧中央区淋巴结清扫或甲状腺全切有40例（占635%）；在DTC cN1组中初次手术方式为甲状腺全切+患侧中央区及侧区淋巴结清扫有39例（813%）。侧区淋巴结出现转移是DTC再次手术的主要原因，DTC cN0组同侧Ⅲ区出现复发的频率最高为597%；DTC cN1组同侧Ⅱ区复发为500%。结论 首次手术术前及术中对甲状腺肿瘤进行精确的评估能减少再次手术的发生，而对于首次手术术前评估为DTC的患者首次手术前对颈侧区淋巴结转移情况进行准确的评估以及规范的手术切除范围能够减少DTC术后复发。

Clinical analysis of reoperation for 222 cases of differentiated thyroid cancer

Abstract Objective: To analyze the causes of reoperation for differentiated thyroid cancer (DTC), and summarize the strategies for reducing reoperation. Methods: To retrospectively analyze 222 patients with differentiated thyroid cancer who underwent reoperation in department of endocrinology and breast surgery of the First Affiliated Hospital of Chongqing Medical University from January 2013 to December 2017, and analyze the causes of reoperation. Results: In this study, there were 219 cases of papillary thyroid carcinoma (PTC) and 3 cases of follicular thyroid cancer (FTC). There were 83 cases (37.4%) of benign thyroid lesions, 62 cases (28.4%) of DTC cN0, 48 cases (21.6%) of DTC cN1 and 28 cases (12.6%) of DTC unknown in the first operation. Total thyroidectomy plus central lymph node dissection and total thyroidectomy were performed in 40 cases (63.5%) in DTC cN0 group and total thyroidectomy plus central and lateral lymph node dissection in 39 cases (82.3%) in DTC cN1 group for the primary surgery. The median interval for reoperation was 7.5 months (range 0.1-218 months), 13 months (range 0.5-132 months) for DTC cN0, and 12 months (range 4-180 months) for DTC cN1. Conclusion: Preoperative evaluation of the first operation for thyroid benign lesions but postoperative pathological examination suggest DTC may soon lead to reoperation, lateral lymph node metastasis and incomplete dissection in first operation are important reasons for reoperation.