甲状腺微小癌的手术方式及减少喉返神经损伤的临床研究  

Clinical studies of surgical methods for small papillary thyroid cancers and prevention of recurrent laryngeal nerve injury

作　　者：何建苗[1] 张庆军[1] 赵华洲[1] 张心慧[1] 邱啸臣[1] 秦荣[1] 杨波[1] 曹志宇[1] 

机构地区：[1]解放军309医院普外科,北京100091

出　　处：《解放军医学杂志》2016年第11期936-939,共4页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨甲状腺微小癌的手术方式及减少喉返神经损伤的方法。方法回顾性分析解放军309医院普外科2006年1月-2013年12月收治的238例甲状腺微小癌患者的临床资料，总结其术前检查方法、手术方式及喉返神经损伤情况。238例患者均为查体时超声检查发现，超声显示结节直径均≤1．0cm，其中术前行甲状腺结节细针穿刺（FNA）检查84例，明确为微小癌72例，假阴性12例，其余均为术后病理证实。所有病例中单侧单发甲状腺微小癌144例，单侧多发甲状腺微小癌46例，双侧多发甲状腺微小癌48例。结果238例患者中采用患侧＋峡部切除＋对侧腺叶次全切除97例，患侧＋峡部腺叶切除s6例，双侧甲状腺切除23例，双侧甲状腺次全切除62例；行颈部淋巴结清扫132例，未行颈部淋巴结清扫106例；其中术中行喉返神经显露122例，共显露喉返神经182条，未显露喉返神经116例。术后随访1～7年，局部复发6例，无远处转移和死亡病例。238例患者中发生喉返神经损伤6例，其中显露喉返神经组1例，未显露喉返神经组5例，均为单侧损伤。结论高频超声检查是发现甲状腺微小癌的重要手段，术前FNA检查是及时判定结节性质的可靠方法，手术切除是治疗甲状腺微小癌的有效方式。选择合理的手术方式是提升甲状腺微小癌远期疗效的关键；术中显露并保护喉返神经能最大限度地减少喉返神经损伤。Objective To investigate the surgical methods for thyroid microcarcinoma （TMC） and prevention of recurrent laryngeal nerve injury. Methods We retrospectively analyzed 238 TMC patients during the January 2006 to December 2013 in 309 Hospital of PLA. All the 238 patients had no clinical symptoms and the diagnosis was made by thyroid ultrasound. Thyroid ultrasound exhibited very small nodules （〈 1cm）. At preoperation, 84 patients received fine needle aspiration （FNA）. Among the 84 patients, 72 were diagnosed with TMC and 12 were false-negative for TMC by FNA. The remaining was proved by postoperative pathological examination. All of these 238 cases, 144 were of unilateral and solitary, 46 unilateral and multiple, and the remaining 48 multiple unilateral. Results Ninety-seven patients were operated for affected side and isthmus resection plus contralateral subtotal resection, 56 for affected side plus isthmus resection, 23 for bilateral thyroid resection, 62 for bilateral thyroid subtotal resection. 132 patients underwent cervical lymph node dissection and the remaining 106 did not. During operation, the recurrent laryngeal nerve was exposed in 122 patients, involving a total of 182 recurrent laryngeal nerves. In the postoperative period （1-7 years）, 6 cases of recurrent and 6 cases of laryngeal nerve injury were found. Conclusions High-intensity focused ultrasound （HIFU） is an important method for diagnosis of TMC. FNA is the most reliable procedure for preoperative determination of the nature of thyroid nodule. Finally, the reasonable and effective surgery is the key to optimize the long-term therapeutic effect and reduce side-effects. During thyroid surgery, to expose and protect recurrent laryngeal nerve is the best means for preventing injury to the recurrent laryngeal nerve.

关 键 词：甲状腺肿瘤 喉返神经损伤 外科手术 

分 类 号：R563.2[医药卫生—呼吸系统]