分化型甲状腺癌外科治疗术式选择(附56例分析)

目的探讨分化型甲状腺癌外科治疗术式的选择。方法回顾性分析1996年1月～2006年12月收治的56例分化型甲状腺癌病例的临床资料,其中男7例,女49例;年龄15～69岁,平均42.7岁。甲状腺癌位于左叶21例,位于右叶30例,位于峡部1例,两叶多发甲状腺癌4例。甲状腺乳头状腺癌54例,滤泡状腺癌2例。行患侧腺叶、峡部加对侧次全切除术29例,患侧腺叶及峡部切除术17例,一侧腺叶次全切除及对侧部分切除术6例,全甲状腺切除术4例。行患侧功能性颈清术39例,双侧功能性颈清术3例,患侧传统性颈清术加对侧功能性颈清术1例及患侧传统性颈清术5例。结果5年生存率94%,3年生存率96%,3例失访。4例行全甲状腺切除术的病例术后均出现甲状腺功能减退,2例出现甲状旁腺功能减退(50%),其他病例均未发生甲状腺功能和甲状旁腺功能减退。本组无一例发生喉返神经麻痹。结论对分化型甲状腺癌,主张行患侧腺叶切除加对侧次全切除或大部切除,如术前发现颈淋巴结肿大,应同时行患侧淋巴结清扫术。而N0患者,除了对高危组患者:男性>41岁,女性>51岁,腺体外乳头状癌或明显侵犯包膜的滤泡型腺癌应行功能性颈清术外,其他随访容易的N0患者可以不必常规颈淋巴结清扫,提倡长期密切随访。

The selection of resionable surgical technique for differentiated thyroid carcinoma

Objective To evaluate the optimal extent of primary thyroidectomy and neck dissection in the patients with differentiated thyroid carcinoma(DTC).Methods Retrospective analysis of 56 cases of DTC.There were 7 males and 49 females with an average age of 42.7 years old.Tumors located in the 1eft lobe in 21 cases,in right lobe in 30 cases,in isthmus in 1 case and involved both lobes in 4 cases.There were 54 cases of papillary thyroid carcinoma and 2 cases of follicular carcinoma.Labectomy for tumor side plus subtotal lobectomy for another side was performed in 29 cases,lobectomy with isthmusectomy was performed in 17 cases,subtotal lobectomy for one side plus partial lobectomy for another side was performed in 6 cases,total thyroidectomy was performed in 4 cases.Unilateral functional neck dissection was performed in 39 cases,bilateral functional neck dissection was performed in 3 cases,traditional neck dissection for tumor side plus functional neck dissection for another side was performed in 1 case and unilateral traditional neck dissection in 5 cases.Results The 5 and 3 years survival rates were 94% and 96%.All 4 cases operated by total thyroidectomy suffered hypothyroidism and 2 of them had hypoparathyroidism postoperatively.There was no hypothyroidism and hypoparathyroidism for other cases.N0 recurrent nerve paralysis occurred in this group.Conclusions We recommend lobectomy for tumor side plus subtotal lobectomy for another side for most of DTC.Selective neck dissection is not necessary for N0 cases unless the patient is in high risk group.