甲状腺癌局部切除术后残癌率的临床分析和意义  

Clinical analysis and significance of residual tumor rate after local resection of thyroid carcinoma

作　　者：章佳新[1] 祝玉祥[1] 邵稳喜[1] 

机构地区：[1]江苏省苏北人民医院甲状腺乳腺外科,江苏扬州225001

出　　处：《中国普通外科杂志》2008年第5期412-414,共3页China Journal of General Surgery

摘　　要：目的探讨甲状腺癌行局部切除术后残癌率的评估,为临床制定再手术的适应证提供理论依据。方法回顾性分析56例在行甲状腺癌局部切除术后,行再次手术治疗患者的临床资料。结果病理证实再手术患者残癌率为42.8%;首次手术前肿瘤直径大于4 cm者残癌率为80.0%;肿瘤小于2 cm者为11.1%;单发结节残癌率为27.5%,多发结节为81.3%;肿瘤侵及甲状腺被膜者残癌率为86.3%,未侵及被膜者为14.7%;首次手术行结节切除术者残癌率为47.6%,行患侧腺叶部分切除者残癌率50.0%,行腺叶次全切除术者为12.5%。再手术前CT和彩色多普勒检查发现癌残留的灵敏度分别为64.0%和60.0%,阳性预测值分别为80.0%和75.0%。结论甲状腺癌局部切除术残癌率较高,再手术是必要的,首次手术前肿瘤情况和CT扫描对筛选再手术患者有首要意义,按适应证选择手术病例,可以使不必要再手术的患者免受手术之苦。Objective To evaluate the rate of residual tumor after local resection of thyroid carcinoma, and provide theoretical basis to determine the indications for re-operation. Methods The clinical data of 56 patients, who had re-operation in our hospital after local resection of thyroid carcinoma, were summarized. Results As confirmed by pathology, the rate of residual tumor of patients was 42.8% at re-operation. When the tumor was larger than 4 cm, or smaller than 2 cm before the first operation, the residual tumor rate was 80% and 11. 1% respectively. The residual tumor rate was 86. 3% in patients with tumor invading thyroid capsule, 14. 7% in patients without capsule invasion, 47. 6% in patients who had only nodule resection, 50% after ipsi-lateral partial lobectomy, and 12.5% after subtotal thyroidectomy. The sensitivity of finding residual tumor by CT and doppler ultrasound examiination before re-operation was 64. 0% and 60.0% respectively, and the positive predictive value was 80.0% and 30.0% respectively. Condusions The rate of residual tumor is high in patients with thyroid cancer operated by local resection. And it＇ s necessary to re-operation. The condition of tumor before the first operation and CT examination are significantfor selection of patients to have re-operation.

关 键 词：甲状腺肿瘤 外科学 残余癌 再手术 

分 类 号：R736.1[医药卫生—肿瘤]