甲状腺右叶滤泡癌伴颈、纵隔、腋窝淋巴结及双肺转移1例报道  

Right follicular thyroid carcinoma with metastases of cervical, mediastinum, axillary lymph nodes, and bilateral lungs: a case report

作　　者：罗涛 苏安平[1] 魏涛[1] 雷建勇[1] 朱精强[1] LUO Tao;SU Anping;WEI Tao;LEI Jianyong;ZHU Jingqiang(Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China; Department of General Surgery, Panzhihua Central Hospital, Panzhihua, Sichuan 617000, P. R. China)

机构地区：[1]四川大学华西医院甲状(旁)腺外科,成都610041 [2]攀枝花市中心医院普外科,四川攀枝花617000

出　　处：《中国普外基础与临床杂志》2020年第8期994-998,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的总结甲状腺滤泡癌(FTC)伴淋巴结及肺转移患者的诊治经验和教训。方法回顾性分析四川大学华西医院(简称"我院")诊治的1例FTC伴颈、腋窝、纵隔淋巴结及双肺转移患者的临床病理资料。结果本例为1例39岁男性患者,因诊断为甲状腺右叶FTC伴全身多处转移入院,拟行甲状腺全切除+双侧中央区及双颈侧区淋巴结清扫+左腋窝淋巴结清扫,术中探查见肿瘤与喉返神经致密粘连,将其与肿瘤分离后信号丢失,右侧中央区见肿大淋巴结向下深入上纵隔,与上纵隔淋巴结融合、固定,左腋窝见较多肿大淋巴结向上延伸入锁骨下区,请胸外科医生会诊,考虑到手术时间已较长,出血约2 000 mL,决定二期行纵隔及左颈手术。术后6+个月,患者于我院胸外科行纵隔淋巴结清扫术+上腔静脉修复术+右肺上中下叶转移瘤切除术+上腔静脉转流术,手术顺利,术后出现声嘶,无低钙、呼吸困难等并发症。术后8个月于我院甲状腺外科行第3次手术,即残余甲状腺全切+左侧中央区及左颈侧区淋巴结清扫+经左侧胸大肌肌间入路左侧腋窝淋巴结清扫(Ⅱ~Ⅲ水平),术后发音同前,无低钙等症状,恢复良好。术后于我院行3次碘-131治疗。定期随访,颈部超声未见确切占位,CT示肺部转移灶稳定。结论从本病例经验提示,对于合并上腔静脉综合征的颈部手术病例要优先处理上腔静脉综合征。由于疑难手术无定式,可根据病情选择非常规入路,根据术中实际情况调整计划,必要时行二期手术。Objective To summarize the experiences and lessons of diagnosis and treatment of follicular thyroid carcinoma(FTC) with lymph node and lung metastases. Method The clinicopathologic data of a case of FTC with metastases of cervical, mediastinum, axillary lymph nodes, and bilateral lungs were analyzed retrospectively. Results The case was a 39 years old male patient, who was diagnosed with the right FTC with multiple metastases. The total thyroidectomy+lymph node dissection in bilateral central and bilateral neck regions+lymph node dissection in the left axillary was intended to perform in the Department of Thyroid and Parathyroid Surgery of the West China Hospital.During the operation, the upper mediastinal lymph node fusion was found, and the tumor was tightly adhered with the recurrent laryngeal nerve, the signal was lost after the adhesion separation. In the right central area, the enlarged lymph nodes penetrated down into the upper mediastinum. More enlarged lymph nodes extended upward into the subclavian area in the left armpit. Considering a longer operation time and about 2 000 mL bleeding amount, the mediastinal and left neck operation was decided to perform in the second stage after consulting with the thoracic surgeon. At more than 6 months after the operation, the patient underwent the mediastinal lymph node dissection+superior vena cava(SVC)restoration+metastatic tumor resection+SVC shunt operation in the Department of Thoracic Surgery of the West China Hospital. The operation was successful, without hypocalcemia, dyspnea, and other complications. At 8 months after the operation, the third operation was performed in the Department of Thyroid and Parathyroid Surgery of the West China Hospital, that was, total residual thyroidectomy+left central and left cervical lymph node dissection+left axillary lymph node dissection(level Ⅱ–Ⅲ). The postoperative pronounce didn’t change, without hypocalcemia and other complications. Three times of iodine ablation therapy were performed in the West China Hospit

关 键 词：甲状腺滤泡癌 淋巴结转移 肺转移 

分 类 号：R736.1[医药卫生—肿瘤]