甲状腺癌中央区域再次手术并发症的临床分析  

Central compartment reoperation for recurrent/persistent differentiated thyroid cancer

作　　者：张亚冰[1] 张彬[2] 鄢丹桂[1] 张溪微[1] 徐震纲[1] 唐平章[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院头颈外科,100021 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所头颈外科,100142

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第4期263-266,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析甲状腺癌再次手术行中央区清扫和/或残叶、复发灶切除术后相关并发症的发生率，探讨再次手术并发症的发生率及再次手术是否安全可行。方法回顾性分析2011年1月1日至2016年3月31日中国医学科学院肿瘤医院头颈外科同一手术组因肿瘤复发或残存行再次手术治疗的109例甲状腺癌患者。探讨再次手术相关并发症的发生率。结果全部患者中仅10例（9.2%）于我院行初次手术治疗，其余患者（90.8%）均为外院行初次治疗。甲状腺及术床区手术方式：61例（56.0%）行补充全甲状腺切除，3例（2.8%）行复发灶切除，2例（1.8%）行补充全甲状腺切除＋复发灶切除，12例（11.0%）患者行全甲状腺切除（初次手术仅行结节剜除）。中央区淋巴清扫：66例（60.6%）患者行双侧中央区清扫，40例（36.7%）患者行单侧中央区清扫。16例（14.7%）出现并发症，其中暂时性甲状旁腺功能低下者11例（10.1%），永久性甲状旁腺功能低下者2例（1.8%），暂时性喉返神经麻痹者9例（8.3%），永久性喉返神经麻痹者2例（1.8%），1例（0.9%）术后出血，随访7～61个月，中位随访时间17.2个月。至随访结束有3例（2.8%）患者出现再次复发，所有患者均存活。结论对于有经验的外科医师，甲状腺中央区域再次手术并发症的发生率并不高，再次手术安全可行。Objective To analyze the incidences of complications after central compartment reoperation for recurrent/persistent differentiated thyroid cancer, and to investigate the safety and feasiblity of central compartment reoperation. Metbord A total of 109 patients who underwent central compartment reoperation for recurrent/persistent differentiated thyroid cancer from January 1,2011 to March 31, 2016 in Cancer Hospital, Chinese Academy of Medical Sciences was analysed retrospectively, and the incidences of reoperation-related complications were evaluated. Results Among 109 patients, only 10 （9. 2% ） patients were treated initially in our hospital and remaining patients （90. 8% ） treated initially in the other hospitals. Surgical approaches for thyroid beds： 61 patients （56. 0% ） underwent supplemented total thyroideetomy, 3 patients （2. 8% ） for removal of recurrent thyroid cancer, 2 patients （ 1.8% ） with supplemented total thyroidectomy and removal of recurrent thyroid cancer, and 12 cases （11.0%） had bilateral thyroid lobeetomy. Central compartment lymph node dissection： 66 patients （ 60. 6% ） underwent bilateral central neck dissection, 40 patients （36.7%） with unilateral central neck dissection. A total of 16 patients （ 14. 7% ） had complications. Transient and permanent vocal fold paralysis developed in 9 （ 8. 3% ） and 2（ 1.8 % ） patients, respectively. Transient and permanent hypoparathyroidism occurred in 2 （ 1.8% ） patients and 11 patients （ 10. 1% ）, respectively. Postoperative bleeding happened in 1 patient （0. 9% ）.with follow-up from 7 to 61 month, median follow-up was 17.2 months. All patients survived, with recurrence in 3 （2. 8% ） patients. Conclusions It seems the incidences of complications for thyroid carcinoma reoperation in central compartment is low for the experienced surgeon. The reoperation was safe and feasible.

关 键 词：甲状腺肿瘤 再手术 手术后并发症 

分 类 号：R736.1[医药卫生—肿瘤]