手术治疗分化型甲状腺癌51例

目的:探讨分化型甲状腺癌的治疗方法。方法:51例均行手术治疗,据病理组织类型、肿瘤大小、病变范围、年龄和颈部淋巴结转移选择不同术式。单侧分化型甲状腺癌行患侧甲状腺及峡部切除或加对侧甲状腺部分切除;双侧者行全甲状腺切除,保留背侧部分组织;高危患者(年龄>45岁,肿瘤>4cm)行颈淋巴结清扫术,术后辅以内分泌治疗。结果:患侧腺叶+峡部切除术13例,患侧腺叶+峡部切除术+对侧腺体部分切除术37例,双侧甲状腺全切除术1例,功能性颈淋巴结清扫术22例,中央区颈淋巴结清扫术16例。术后发生神经损伤及甲减3例,无手术死亡病例。随访5年以上者46例,无死亡病例,颈部淋巴结转移3例,无远处转移病例。结论:分化型甲状腺癌应根据病理组织类型、肿瘤大小、病变范围、年龄和颈部淋巴结转移选择不同手术方式。

Surgical treatment of 51 cases of differentiated thyroid carcinoma

Objective：To investigate the treatment of differentiated thyroid carcinoma.Methods：Fifty-one patients received different surgical resection regarding the type of pathologic histology,tumor size,range of lesion,ages and jugular lymphatic metastasis.Patients with unilateral differentiated thyroid carcinoma were given the resection of ipsilateral isthmus of thyroid lobe or plus partial contralateral gland,and those with bilateral one were undergone total thyroidectomy,with partial retaining of the dorsal thyroid.High-risk patients（age〉45-year-old,tumor size〉4 cm）were performed by modified radical neck dissection besides postoperative endocrine therapy.Results：Thirteen cases underwent the resection of ipsilateral lobe with isthmus,37 received surgical removal of ipsilateral lobe with isthmus plus partial contralateral gland and 1,total thyroidectomy.Of the 51 cases,22 underwent modified radical neck dissection and 16,neck dissection of central region.Three were complicated with postoperative nerve injury and hypoparathyroidism,but no perioperative deaths occurred.The follow-up of 51 patients more than 5 years suggested that no death occurred,but 3 relapsed with jugular lymphatic metastasis.No distant metastasis occurred.Conclusion：Treatment of the differentiated thyroid carcinoma should be based on the type of pathologic histology,size of tumor,range of lesion,age and jugular lymphatic metastasis.