分化型甲状腺癌局部切除术后再手术方式及治疗

目的探讨分化型甲状腺癌局部切除术后再次手术的手术范围及治疗经验。方法回顾性分析2004年6月至2010年6月收治的137例因首次手术按良性肿物行局部切除，术后病理证实为分化型甲状腺癌，再入院行二次手术患者的临床资料。结果再次手术行患侧残余甲状腺切除加对侧甲状腺全切除78例，对侧甲状腺全切除11例，对侧甲状腺近全切除4例，双侧残余甲状腺切除22例，患侧残余甲状腺加峡部切除15例，对侧残余甲状腺切除7例；同期行单侧淋巴结清扫46例，双侧淋巴结清扫15例。再次手术暂时性和永久性喉返神经损伤发生率分别为2．9％（4／137）及0．7％（1／137），暂时性和永久性甲状旁腺功能低下发生率分别为3．6％（5／137）及1．5％（2／137）。所有患者术后随访6个月至6年，均无甲状腺肿瘤复发及颈部淋巴结转移。结论分化型甲状腺癌患者局部切除术后，根据首次手术情况和术后病理结果等合理选择再次手术方式，术中细心操作，可有效减少再次手术并发症，改善预后。

Reoperation for differentiated thyroid carcinoma after local resection

Objective To investigate the extent of reoperation for patients of differentiated thyroid carcinoma（DTC） who require total thyroideetomy. Methods The data of 137 patients undergoing reoperation for DTC were analyzed. These 137 patients were firstly diagnosed as benigh tumors and underwent local resection in our department from June 2004 to June 2010, however, they were proved to be DTC by postoperative pathology. Results In the reoperation, 78 cases received ipsilateral residual thyroid resection plus contralateral lobectomy, 11 cases received contralateral lobectomy, 4 cases received contralateral near total lobectomy, 22 cases received bi- lateral remnant resection, 15 cases received ipsilateral remnant resection plus isthmuscectomy, and 7 cases received contralatera] remnant resection. 46 cases received unilateral cervical lymph node dissection, and 15 cases received bilateral cervical lymph node dissection. The incidence of temporary and permanent recurrent laryngeal nerve injury was 2. 9% （4/137）and 0. 7% （ 1/137 ）respectively. The incidence of temporary and permanent hypoparathyroidism was 3.6% （5/137）and 1.5% （2/137）respectively. There was no clinical evidence of recurrence or cervical lymph node metastasis during the 6 months to 6 years of follow-up. Conclusions For DTC patients after local resection, reoperation methods should be selected according to the first operation and pathological results. Careful operation can effectively reduce complications and improve prognosis.