76例分化型甲状腺癌手术方式及诊断的临床分析  

Surgical Treatment and Diagnosis of Differentiated Thyroid Carcinoma: An Analysis of 76 Cases

作　　者：潘平东[1] 钟强文[1] 常春[1] 

机构地区：[1]嘉应学院医学院附属医院,广东梅州514031

出　　处：《中国医学创新》2015年第1期14-16,共3页Medical Innovation of China

摘　　要：目的:探讨分化型甲状腺癌的诊断和手术方式。方法:对本院2010年1月-2013年12月收入院后经手术治疗的分化型甲状腺癌76例的临床资料进行回顾性分析。其中合并结节性甲状腺肿18例,甲状腺腺瘤5例,桥本氏甲状腺炎3例,原发性甲亢1例。结果:术中冰冻切片诊断68例,阳性率为89.47%。术后病理报告乳头状癌69例(90.79%),滤泡样癌7例(9.21%),伴有区域淋巴结转移47例(61.83%),肿瘤浸润包膜13例(17.11%),其中浸出包膜外9例(11.84%)。手术方式主要采取患侧腺叶、峡部切除及对侧腺叶次全切除、颈部淋巴结清扫术或甲状腺全切、颈部淋巴结清扫术。术后甲状腺功能减退5例,声音嘶哑9例(7例为暂时性,2例为永久性),7例低钙抽搐或肢端麻木。全部病例获随访,局部复发者12例,颈部淋巴结复发者5例,远处转移者3例。结论:术中冰冻切片检查有助于甲状腺癌的诊断及手术方式选择,分化型甲状腺癌应根据病理组织类型、肿瘤大小、病变范围、年龄和颈部淋巴结转移选择不同手术方式。Objective： To investigate the diagnosis and surgical selection in differentiated thyroid carcinoma.Method： Clinical data of 76 differentiated thyroid carcinomas were analyzed retrospectively from January 2010 to December 2013. 18 cases were carcinoma with nodular goiter, 5 cases were carcinoma with thyroid adenoma,3 cases were carcinoma with hashimoto thyroiditis, 1 case was carcinoma with hyperthyroidism. Result： 68 patients（ 89.47%） were diagnosed according to intraoperative fast frozen section. 69 cases（90.79%） were approved papillary thyroid carcinoma, 7 cases（9.21%） were follicular thyroid carcinoma. Especially inside of diolame invasion in 13 patients（17.11%） and outside of diolame invasion in 9 patients（11.84%）. Neck dissection was performed in 64 patients, and 47 of them（ 61.83%） had cervical lymph node metastasis. The various styles of thyroidectomy were performed, 7 cases showed temporary vocal cord paralysis, 2 cases showed permanent after operation; 7 cases had convulsion or limbs numbness due to hypocalcemia, and 5 cases had thyroid function decrease. Follow up of all cases showed local recurrence in 12 patients, cervical lymph node recurrence in 5 patients and distant metastasis in 3 patients. Conclusion： Intraoperative fast frozen section is helpful for the diagnosis and the choice of operation method. The various surgical selection of thyroidectomy are performed according to the different pathological types, tumor type,pathological changes scope,age and cervical lymph node metastasis.

关 键 词：甲状腺癌 手术方式 术中冰冻切片 

分 类 号：R736.1[医药卫生—肿瘤]