无转移分化型甲状腺癌首次手术范围的选择

目的探讨无转移分化型甲状腺癌首次手术范围的选择。方法总结本院1995年1月至2004年12月经外科手术治疗的504例分化型甲状腺癌患者的临床资料并进行分析。其中首次手术无转移的病例329例,按TNM分期,有92．1％（93例）的T1病例,88．3％（166例）的T2病例,91．7％（22例）的T3病例和75％（12例）的T4病例行范围小于全甲状腺切除的术式。比较T分期各组间及不同手术范围间的复发情况。结果有37例（8．9％）复发,其中首次手术无转移者29例。T1和T2组的复发比例无差异（P〉0．05）;T1和T2组的复发比例分别与T3或T4组比较,差异均有统计学意义（P〈0．05）。T1和T2组无转移分化型甲状腺癌采用范围小于全甲状腺切除术式的复发比例比较,差异无统计学意义（P〉0．05）。术后喉返神经损伤率为1．2％,2．0％的患者出现一过性甲状旁腺功能低下,无一例发生永久性甲状旁腺功能低下。结论对于T1和T2期的无转移分化型甲状腺癌,选择范围小于全甲状腺切除术,特别是甲状腺次全切除术是可取和合理的手术方式,既可有效清除肿瘤,又可有效避免术后并发症;对于T3和T4期无转移分化型甲状腺癌应采取全甲状腺切除术。

Selection of the initial surgery extent for differentiated thyroid cancer without metastasis

OBJECTIVE: To discuss the selection of the initial surgery extent for differentiated thyroid cancer (DTC) without metastasis. METHODS: The clinical data of 504 cases with DTC, who accepted the surgical treatment from Jan 1995 to Dec 2004, were analyzed and studied. There were 329 cases without metastasis. The operative extents less than total thyroidectomy were performed on 93 cases (92.1%) with stage T(1), 166 cases (88.3%) with stage T(2), 22 cases (91.7%) with stage T(3) and 12 cases (75.0%) with stage T(4). The recurrence situation after the initial surgery was compared between different T-stage groups and between different surgical extents, total and less than total thyroidectomy. RESULTS: The recurrence of DTC was found in 37 cases of the follow-up cases (8.9%), including 29 cases without metastasis in the initial surgery. There was no significant difference in the recurrent rate between T(1) and T(2) groups (P>0.05). The significant difference was found in recurrent rate between T(1) and T(3) or T(4) groups, T(2) and T(3) or T(4) groups (P<0.05). No significant difference in the ratio of the initial surgical extent less than total thyroidectomy was found between stage T(1) and T(2) cases without metastasis (P>0.05). The rate of the recurrent laryngeal nerve injury was 1.2%. The transient hypoparathyroidism happened in 2% of the cases, without the permanent hypoparathyroidism. CONCLUSIONS: The surgical extent less than total thyroidectomy, especially subtotal thyroidectomy, is rational and available to stage T(1) and T(2) cases of DTC without metastasis. It can effectively remove the tumor and avoid postoperative complications. Total thyroidectomy should be performed on stage T(3) and T(4) cases of DTC.