甲状腺癌局部切除术后再手术268例临床经验总结

目的分析甲状腺癌再手术临床资料，探讨其更合理术式。方法总结1984—2000年间高分化型甲状腺癌局部切除术后，进行再次手术治疗268例患者临床资料，其中男59例，女209例；首次在其他医院行甲状腺肿块切除术或甲状腺癌患侧腺叶部分切除术256例患者，在辽宁省肿瘤医院甲状腺癌患侧腺叶次全切除12例患者。第二次手术甲状腺全切除6例，均为双侧癌；峡部扩大切除1例，为峡部癌；一侧残叶及峡部切除261例。同期行颈清扫术196例，其中颈经典性清扫术94例，改良性颈清扫术102例。结果病理结果证实残叶有癌残留78例，无癌残留190例，癌残留率29．1％（78／268）。术后病理淋巴结转移癌95例，淋巴转移率48．5％（95／196）。喉返神经损伤发生率1．1％（3／268）。应用直接法计算生存率，甲状腺癌再手术5年生存率94．0％（251／267），10年生存率85．2％（127／149）。结论甲状腺癌局切术后癌残留率较高，有选择的手术治疗是必要的。正确选择适应证和术式，可以减少癌残留复发。

Re-operation for thyroid carcinoma

Objective To evaluate the results of re-operation of thyroidectomy for patients of thyroid carcinoma. Methods 268 patients of thyroid carcinoma received completion thyroidectomy were retrospectively reviewed from 1984 to 2000.There were 59 males and 209 female cases. 256 cases had received nodule enucleating or partial thyroidectomy in other hospitals and 12 cases had unilateral subtoal thyroidectomy in this hospital.The types of reoperation were: Total thyroidectomy for bilateral thyroid carcinoma (6 cases); expand isthmectomy for isthmus carcinoma (1 case).Lobectomy plus isthmectomy for unilateral disease (261)Simultaneous neck dissections were performed in 196 cases. Among them, 94 cases had classical neck dissection,102 cases had modified neck dissection. Results Pathological results confirmed that there were 78 cases with residual thyroid carcinoma. The rate of residual carcinoma was 29.1%(78/268). There were 95 cases with lymphnode metastasis. The rate of lymphnode metastasis was 48.5%(95/196). The rate of recurrent laryngeal nerve injury was 1.1%(3/268).The 5-year and 10-year survival rates of patients were 94.0%(251/267) and 85.2%(127/149) respectively. Conclusions The residual carcinoma of completing thyroidectomy was high. Therefore re-operations of thyroid in selected cases were necessary.