原发性甲状腺功能亢进合并甲状腺癌的术式探讨  

Clinical treatment of primary hyperthyroidism complicated with thyroid cancer

作　　者：菅雁兵 王冰[1] 彭君[2] 田文[1] Jian Yanbing;Wang Bing;Peng Jun;Tian Wen(Department of General Surgery,the First Medical Center of PLA General Hospital,Beijing 100853,China;Department of Anesthesiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]解放军总医院第一医学中心普通外科,北京100853 [2]武汉大学中南医院麻醉科,武汉430071

出　　处：《中华内分泌外科杂志》2019年第4期269-272,共4页Chinese Journal of Endocrine Surgery

基　　金：北京市科学技术委员会科技计划课题(Z141107002514102).

摘　　要：目的探讨原发性甲状腺功能亢进(简称:原发性甲亢)合并甲状腺癌不同手术方式的临床治疗效果。方法对2011年1月至2017年12月就诊于解放军总医院普通外科原发性甲亢合并甲状腺癌患者进行临床资料的收集,包括术前准备、手术方式等,探讨不同手术方式的临床治疗效果及预后。结果对30例术前超声检査为单个结节、未怀疑淋巴结转移且术中无腺体外累及的患者行患侧甲状腺+峡部切除及对侧甲状腺近全切除术,在对侧腺叶的喉返神经入喉点处保留V1g的甲状腺组织(即<1cm×1cm×1cm体积的腺体组织)。对19例术前超声怀疑甲状腺癌且腺体内多发结节、双侧癌、怀疑淋巴结转移、肉眼见有包膜外侵的患者行双侧甲状腺全切除术。所有获得随访的患者均未出现甲亢或甲状腺癌复发及转移。结论对甲亢合并甲状腺癌的治疗应以甲状腺癌根治兼顾防止甲亢复发为原则,并根据肿瘤的大小、位置、病理类型及复发危险度分层制定个性化手术方案。原发性甲亢合并甲状腺癌患者常规行中央区淋巴结清扫术是必要的,特别是年轻、肿瘤直径较大及肿瘤侵犯被膜及周围组织者,有利于提高预后。Objective To investigate the clinical effects of different surgical methods for primary hyperthyroidism complicated with thyroid cancer. Methods The clinical data of patients with primary thyroid hyperthyroidism complicated with thyroid cancer who visited our hospital from Jan. 2011 to Dec. 2017 were collected, including preoperative preparation, operation mode and so on, to explore the clinical effect of different surgical methods. Results Thirty patients with single nodules preoperatively, no suspected lymph node metastasis and no intraoperative involvement of glandular extravasation were performed Ipsilateral thyroid + isthmectomy and contralateral thyroidectomy. Less than lg of thyroid tissue was retained at the throat of the contralateral gland (less than 1 cm x 1 cm x 1 cm volume of glandular tissue). Double-sided total thyroidectomy was performed on 19 patients with preoperative ultrasound suspects cancer and multiple nodules, bilateral cancers, suspected lymph node metastases, and extracapsular invasion. All patients who were followed did not show recurrence or metastasis of hyperthyroidism or thyroid cancer. Conclusions The treatment of hyperthyroidism combined with thyroid gland should be based on the principle of thyroid cancer cure and relapse prevention of hyperthyroidism and according to the tumor size, location, pathological type and risk of relapse stratified development of personalized surgery program. Conventional central lymph node dissection is necessary for patients with primary hyperthyroidism complicated with thyroid cancer, especially for those with young age, large tumor diameter, and invasion of the capsule and the surrounding tissue.

关 键 词：原发性甲状腺功能亢进 甲状腺癌 甲状腺切除术 

分 类 号：R736.1[医药卫生—肿瘤] R581.1[医药卫生—临床医学]