分化型甲状腺癌78例回顾性分析  

Retrospective analysis of 78 cases with differentiated thyrbid carcinoma

作　　者：张同军[1] 薛栋[1] 吴俊本[1] 张成德[1] 夏修良[1] 

机构地区：[1]滨州医学院附属滨州市人民医院普通外二科,256610

出　　处：《中国综合临床》2011年第6期617-620,共4页Clinical Medicine of China

摘　　要：目的探讨分化型甲状腺癌的诊治方法选择。方法我院2002年2月至2008年1月收治78例分化型甲状腺癌患者，均给予手术治疗，根据肿瘤大小、病灶数量、颈部淋巴结转移和年龄选择不同术式。单侧分化型甲状腺癌行患侧甲状腺及峡部切除或加对侧甲状腺部分切除术；双侧者行甲状腺全切或近全切除术；高危患者（年龄〉45岁，肿瘤〉4cm，肿瘤≤4cm但超出甲状腺包膜）行颈淋巴结清扫术，术后辅以内分泌治疗。患侧腺叶＋峡部切除术11例，患侧腺叶＋峡部切除术＋对侧腺体部分切除术19例，甲状腺近全切除术26例，双侧甲状腺全切除术22例；功能性颈淋巴结清扫术25例，中央区（Ⅵ区）颈淋巴结清扫术23例。结果乳头状癌68例（87．18％），滤泡状癌10例（12．82％）；中央区淋巴结转移26例。术后并发症：短期低钙手足麻木12例（15．38％），暂时性喉返神经麻痹8例（10．26％），永久性声音嘶哑2例（2．56％），乳糜漏3例（3．85％）。74例获随访，随访率为94．87％，随访6个月～6年。6例局部复发淋巴结转移，经再次手术切除，无远处转移。生存率97．30％（72／74）。结论肿瘤大小、病灶数量、颈部淋巴结转移和年龄应作为分化型甲状腺癌手术方式选择的依据，对于高危患者应常规行中央区淋巴结清扫。Objective To investigate the differentiated thyroid carcinoma diagnosis and treatment options. Methods From Feb. 2002 to Jan. 2008,78 patients received different surgical resection regarding the type of tumor size, number of tumor, ages and jugular lymphatic metastasis. Patients with unilateral differentiated thyroid carcinoma underwent the resection of ipsilateral isthmus of thyroid lobe or plus partial contralateral gland, and those with bilateral-lobe underwent total thyroidectomy or near-total thyroidectomy. High-risk patients （ age 〉 45 years, tumor size 〉 4 cm, tumor size ≤4 cm, but surpass the envelop of thyroid ） were performed by functional neck dissection or lymph node dissection of central region （ VI area） besides postoperative endocrinetherapy. Results Eleven cases underwent the resection of ipsilateral lobe with isthmus, 19 cases underwent surgical removal of ipsilateral lobe with isthmus plus partial contralateral gland, 26 cases underwent near-total thyroidectomy and 22 total thyroidectomy. 25 cases underwent functional neck dissection, 23 cases underwent neck dissection of central region. There were 68 papillary thyroid carcinoma （ 87. 18% ）, 10 follicular thyroid carcinoma （ 12. 82% ）. There were 26 cases with lymphatic metastasis of Ⅵ area. Postoperative complications included 12 cases （ 15.38% ） with deadlimb caused by hypocalcemia, 8 cases （ 10. 26% ） with transient recurrent nerve paralysis, 2 cases （2. 56% ） with permanent injury of recurrent laryngeal nerves, 3 cases （3.58%） with chylous fistula. Seventy-four（94. 87% ）cases were followed up postoperatively for a period from 6 months to 6 years, which showed that no death occurred, but 6 relapsed with jugular lymphatic metastasis, after reoperation no distant metastasis occurred. Survival rate was 97. 30% （72/74）. Conclusion Treatment of the differentiated thyroid carcinoma should be based on the size of tumor, number of tumor, age and jugular lymphatic metastasis. Lymph node dissection of cen

关 键 词：分化型甲状腺癌 外科手术 

分 类 号：R736.1[医药卫生—肿瘤]