甲状腺微小乳头状癌手术126例体会  

Treatment of 126 Cases of Thyroid Microcarcinoma

作　　者：蔡丽生[1] 陈秋贤[1] 方顺勇[1] 连明桥 沈俊涛[1] 洪建明[1] 

机构地区：[1]福建医科大学附属漳州市医院普外二科,漳州363000

出　　处：《中国微创外科杂志》2017年第9期772-774,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：福建省卫生厅青年科研课题(编号:2015-2-29)

摘　　要：目的探讨甲状腺微小乳头状癌手术的治疗方法。方法 2015年1月~2016年5月,我科收治甲状腺微小癌126例,行患侧加峡部切除或甲状腺全切除术及中央区淋巴结清扫术,中央区淋巴结转移者行同侧选择性区域淋巴结清扫术。统计手术并发症、术后病理及恢复情况。结果发现隐匿性多发癌4例;术中证实中央区转移45例(35.7%),行横行小切口侧颈区选择性区域淋巴结清扫术(清扫Ⅱ、Ⅲ、Ⅳ、部分Ⅴ区),术后病理侧颈区淋巴结转移23例。术后声音嘶哑3例,饮水呛咳2例,短暂性低钙血症15例(均为甲状腺全切除术后),术后乳糜淋巴漏4例(均为侧颈区淋巴结清扫术后)。无术后切口出血导致再次手术。结论甲状腺微小癌具有较高的中央区淋巴结转移率,中央区淋巴结转移者侧颈区淋巴结转移率高,建议对甲状腺微小癌行常规小切口甲状腺全切除及选择性区域淋巴结清扫术。Objective To explore the optimal surgical treatment of thyroid microcarcinoma. Methods Clinical d a ta of 126 patients with thyroid microcarcinoma underwent total thyroidectomy or lobectomy and isthmusectomy in our hospital from January 2015 to May 2016 were analyzed retrospectively. All patients routinely received central compartment lymph node dissection, and an additional prophylactic lateral cervical lymph node dissection was performed for tumor side in patients with central compartment lymph node metastasis. Surgical complications, postoperative pathologic results and postoperative recovery were evaluated. Results Multiple occult carcinoma was found in 4 cases. Central compartment lymph node metastasis occurred in 35.7% （45/126） of patients confirmed during operation, which were given prophylactic lateral cervical lymph node dissection through a small infestative skin incision （the II , IE , IV regions and pa rtia l V region） . A total of 23 c ases were found with latera l cervical lymph node metastasis. Postoperatively there were 3 cases of hoarseness, 2 cases of cough when drinking water, 15 cases of temporary hypocalcemia （after total thyroidectomy） , and 4 cases of lymphatic leakage （ after prophylactic lateral cervical lymph node dissection） . There was no re-operation due to postoperative hemorrhage. Conclusions The incidenc e of c entra l compartment lymph node metastasis is relatively high in patients with thyroid microcarcinoma, resulting in high rate of the lateral cervical lymph node metastasis. Thus, total thyroidectomy combined with cervical regional lymph node dissection should be recommended for patients with thyroid microcarcinoma.

关 键 词：甲状腺腺叶切除术 颈淋巴结清扫术 甲状腺微小癌 

分 类 号：R736.1[医药卫生—肿瘤]