Ⅵ区淋巴结清扫在快速病理不能定性的甲状腺肿瘤术式选择中的意义  

The choice of primary operation for thyroid tumors that can not be diagnosed by frozen section

作　　者：司文军 王太洪[2] 卢有胜[2] 

机构地区：[1]沭阳县中医院普外科,江苏223600 [2]江苏省肿瘤医院普外科,江苏210009

出　　处：《中国肿瘤外科杂志》2012年第6期335-337,共3页Chinese Journal of Surgical Oncology

摘　　要：目的探讨术中快速病理不能定性的甲状腺单侧腺叶肿瘤初次手术方式的选择。方法 1998年1月至2010年6月江苏省肿瘤医院及沭阳市中医院普外科共收治了术中快速病理不能定性的甲状腺单侧腺叶肿瘤78例。若临床怀疑为恶性肿瘤初次手术选择"甲状腺单侧腺叶切除+峡部切除+单侧中央区(Ⅵ区)淋巴结清扫"36例(B组),否则初次手术选择"甲状腺单侧腺叶切除+峡部切除"42例(A组)。比较两组术后确诊为甲状腺癌的比例、5年内追加手术率及两次术后并发症的发生率。结果相比较A组病例,B组病例初次术后有更高的恶性肿瘤确诊率(P=0.034),更低的5年追加手术率(P=0.002),而初次术后并发症的发生率没有增加(P=0.526),同时降低了再次术后一过性低钙血症的发生率(P=0.038)。结论对术中快速病理不能定性的甲状腺单侧腺叶肿瘤,若临床高度怀疑为恶性,初次手术选择"甲状腺单侧腺叶切除+峡部切除+单侧中央区淋巴结清扫(Ⅵ区)"是安全、有效的。Objective To explore a suitable primary surgical procedure of unilateral thyroid tumors that can not be diagnosed by frozen section. Methods The way of operation for 78 cases with unilateral thyroid tumors which could not be diagnosed by frozen section were studied. 36 patients underwent unilateral thyroidectomy ＋ isthmus resection ＋ unilateral central lymph node resection （ Ⅵ ） （ group B） because of diagnosed cancer in op- eration. Other 42 cases underwent unilateral thyroidectomy ＋ isthmus resection（ group A）. The ratio of postoper- ative thyroid cancer diagnosed by routine pathology, additional surgery in five years and postoperative complica- tions were compared between the two groups. Results Compared to group A , patients in group B had higher ratio of postoperative carcinomas （ P = 0.034）, lower ratio of additional surgery in 5-year （ P = 0.002 ）, no in- creased ratio of primary surgery complications （ P = 0. 526） and lower ratio of transient hypocalcemia alter addi- tional surgery （P = 0. 038 ）. Conclusions For unilateral thyroid tumors that can not be diagnosed by frozen section but highly suspected cancer in clinic, the selection of unilateral thyroidectomy ＋ isthmus resection ＋ uni- lateral central lymph node resection （Ⅵ ） is an effective and safe method.

关 键 词：术中快速病理 甲状腺肿瘤 甲状腺手术 中央区淋巴结 术后并发症 

分 类 号：R736.1[医药卫生—肿瘤]