甲状腺癌二次手术原发灶的切除范围探讨  

Re-operation extent of primary lesion of thyroid cancer

作　　者：于文斌[1] 张乃嵩[1] 曾宗渊[2,3] 孙俊勇[1] 魏炜[1] 

机构地区：[1]北京大学临床肿瘤学院,北京肿瘤医院暨北京市肿瘤防治研究所头颈外科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]华南肿瘤学国家重点实验室,广东广州510060 [3]中山大学肿瘤防治中心头颈科,广东广州510060

出　　处：《癌症》2009年第6期652-654,共3页Chinese Journal of Cancer

摘　　要：背景与目的:较多甲状腺癌的患者因为肿瘤的残留而需要行第二次手术,本研究探讨甲状腺癌二次手术原发灶的切除范围。方法:回顾性研究本院收治甲状腺癌患者因手术范围不足,而需再次手术的55例患者,其中男7例,女48例。年龄介于18～56岁,中位年龄33.5岁。所有患者均行患侧甲状腺残叶+峡部+同侧带状肌+同侧Ⅵ区淋巴脂肪组织的切除。结果:术后病理证实有癌残留29例,残留率为52.73%(29/55),其中单纯原发灶残留8例,单纯Ⅵ区淋巴结转移7例,原发灶与Ⅵ区淋巴结同时有残留14例。Ⅵ区淋巴结残留共21例,共有转移的淋巴结45枚,平均每例有转移淋巴结2.14枚,术后病理4例肿瘤细胞与肌肉组织关系密切。结论:患侧甲状腺残叶+峡部+同侧带状肌+同侧Ⅵ区淋巴脂肪组织是甲状腺癌二次手术原发灶的基本切除范围。Background and Objective. Many thyroid cancer patients need to receive second operation because of tumor residue. This study was to explore the resection extent of primary lesion in re-operation of thyroid carcinoma.Methods. Clinical data of 55 thyroid carcinoma patients who received re-operation were reviewed. The patients, including seven men and 48 women, were aged of 18-56. All patients received ipsilateral residual Iobectomy,isthmectomy, ipsilateral anterior cervical muscle and level VI lymph node dissetion. The optimal extent for radical re-resection of primary lesion was explored. Results. Tumor residue was proved by pathology in 29 patients, with a rate of 52.73%. Of the 29 patients, eight had primary lesion residue, seven had level Vl lymph node residue, and 14 had both. Tumor cells were connected with muscle in four patients. Forty-five metastatic lymph nods were found. Conclusion. Ipsilateral residual Iobectomy, isthmectomy, ipsilateral anterior cervical muscle and level VI lymph node dissetion is the basic re-resection extent of primary lesion for thyroid carcinoma patients.

关 键 词：甲状腺肿瘤 外科手术 二次切除 切除范围 

分 类 号：R736.1[医药卫生—肿瘤]