甲状腺癌55例诊治体会

总结了１９８０～１９９２年诊治甲状腺癌５５例的经验。研究了甲状腺癌术前Ｂ超诊断多呈实质不均结节和术中常有颈前肌粘连的特征对手术中诊断和术式的指导意义。提出了甲状腺囊性结节可以做摘除术或切除部分腺体，而实质不均质结节者至少应做患侧叶甲状腺全切的见解。体会：结节与颈前肌粘连或结节直径大于３．０ｃｍ应加做峡部切除，加或不加对侧叶大部切除及淋巴结清扫。如术后病理报告为腺内型和直径小于３．０ｃｍ无转移腺外型乳头状或滤泡状癌，可不必再做第二次手术。直径超过３．０ｃｍ腺外型滤泡状癌或髓样癌，虽做过患侧叶甲状腺全切还应再第二次扩大手术。

EXPERIENCE IN DIAGNOSIS AND TREATMENTOF 55 CASES OF THYROID CANCER

A review is given on experience in diagnosis and treatmentof thyroid cancer from 1980 to 1992 in 55 cases.It is helpful to confirming intraoperative diagnosis and selection of operative procedures that preoperatively,parenchyma of thyroid nodules is found to be heterogeneous with B-ultrasoundgraph and intraoperatively,adhesion between the nodules and the cervical anterior muscle is often discovered,All the cystic nodules or partial gland body may be removed for patients with cystic nodules.For heterogeneous solidary masses,total excision of thyroid affected lobe should be at least carried out.For parenchyma-heterogeneous nodules large than 3cm in diameter or adhesion to the cervical anterior muscle,should be treated by total excision plus excision of thyroid isthmus,and should also consider that whether the subtotal thyroidetomy on contralateral lobe and lymphnodes dissection may be performed or not.For intraacinous and extraacinous papillary carcinoma or follicular carcinoma less than 3cm in diameter without metastasis,which were confimed by pathological examination,the second operation is not necessary,while for extraacinous follicular or medullary carcinoma large than 3cm in diameter and their affected lobe undergoing total excision,it is necessary to proceed to second extended excision.