分化型甲状腺癌再手术252例临床分析  

Differentiated thyroid carcinoma undergoing reoperation:A clinical analysis of 252 cases

作　　者：刘文波 张浩[1] 张平[1] 贺亮[1] 张挺[1] 吕承洲[1] 邵亮[1] 张大林[1] LIU Wen-bo ZHANG Hao;ZHANG Ping(Department of Thyroid Surgery the First Affiliated Hospital of China Medical University Shenyang 110001, China)

机构地区：[1]中国医科大学附属第一医院甲状腺外科,辽宁沈阳110001

出　　处：《中国实用外科杂志》2018年第6期646-649,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨分化型甲状腺癌(DTC)再手术的原因和对策。方法回顾性分析中国医科大学附属第一医院2011年1月至2015年12月收治的252例DTC再手术病例的临床资料,总结再手术原因并探讨处理对策。结果再手术原因有:颈侧方淋巴结转移、诊断延误补充根治、残余腺体再发癌变、中央区淋巴结转移和再手术术前临床误诊。颈侧方淋巴结转移91例(36.1%),其中再手术时间<1年者38例(41.8%);诊断延误补充根治58例(23.0%),腺体残癌发生率25.9%,淋巴结转移发生率36.2%;残余腺体再发癌变54例(21.4%),其中首次手术范围小于腺叶者22例(40.7%);中央区淋巴结转移27例(10.7%),其中初次手术已行中央区清扫者26例,占比96.3%;再手术前临床误诊22例(8.7%),因可疑淋巴结来诊13例,再手术前均未行细针穿刺细胞学(FNAC)检查。结论影像学仔细评估及规范的手术切除范围是减少DTC再手术的关键。Objective To explore the causes and countermeasures of reoperation of differentiated thyroid cancer （DTC）.Methods The clinical data of 252 cases of DTC reoperation performed in the First Affiliated Hospital of China Medical University from January 2011 to December 2015 were analyzed retrospectively.The cause of reoperation and propose countermeasures were summarized. Results The group of reoperation for 5 reasons：lateral cervical lymph node metastasis,delayed diagnosis and radical recuperation,residual gland recurrence,lymph node metastasis in central area and preoperative misdiagnosis before operation. There were 91 cases （36.1%） of cervical lymph node metastases,38 cases （41.8%） of those with less than 1 year of reoperation. Delayed diagnosis and replacement therapy were performed in 58 cases （23.0%）.The rate of residual cancer in the gland was 25.9% and the rate of lymph node metastasis was 36.2%. Recurrence of residual gland cancer occurred in 54 cases （21.4%）,of which the first operation was less than the glandular leaf area in 22 cases,accounting for 40.7%. Central lymph node metastasis occurred in 27 cases（10.7%）,of which the first operation in 26 cases （96.3%） was central clearing area. There were 22 cases （8.7%） of clinical misdiagnosis before operation,13 cases were diagnosed due to suspicious lymph nodes,and no puncture pathology was observed before operation. Conclusion Careful assessment before surgery and the normative surgical treatment is the key to reduce the reoperation rate of DTC.

关 键 词：分化型甲状腺癌 再手术 

分 类 号：R6[医药卫生—外科学]