对比解读手术治疗分化型甲状腺癌和Graves病甲状腺功能亢进在中美指南中的建议  

Interpretation of Chineseguidelines for surgical treatment of differentiated thyroid cancer and Graves disease hyperthyroidism compared with U.S.guidelines

作　　者：张浩[1] 孙威[1] ZHANG Hao;SUN Wei(Department of Thyroid Surgery,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：《中国实用内科杂志》2023年第11期903-906,共4页Chinese Journal of Practical Internal Medicine

基　　金：辽宁省应用基础研究计划项目(2022020225-JHZ/1013)。

摘　　要：手术是治疗分化型甲状腺癌(DTC)的首选方式,也是治疗Graves病甲状腺功能亢进(简称Graves病甲亢)的方式之一。2022年及2023年中国发布了《中国甲状腺功能亢进症和其他原因所致甲状腺毒症诊治指南》和《甲状腺结节和分化型甲状腺癌诊治指南(第二版)》。在DTC原发灶的手术范围方面,对于直径<1 cm、无高危因素DTC的原发灶切除范围和全甲状腺切除指征,中美两国指南达成一致。而对于无高危因素、直径1~4 cm的DTC原发灶切除范围,中国指南更倾向于全甲状腺切除。DTC颈部淋巴结清扫方面,中美两国指南争议的焦点仍为是否对T1、T2期、非侵袭性的临床淋巴结阴性DTC行预防性中央区淋巴结清扫。此外,中国指南新增腔镜或机器人甲状腺外科手术推荐。Graves病甲亢的外科治疗部分,中美两国指南的术前准备和术式选择推荐一致。术后管理方面,中国指南侧重于手术并发症的管理,而美国指南则主要推荐了术后低钙治疗、停用抗甲状腺药物、停用β-受体阻滞剂、服用左甲状腺素和监测甲功的时机。Surgery is the first choice for the treatment of differentiated thyroid cancer,and it is also one of the methods for the treatment of Graves'disease.In 2022 and 2023,China issued"Guidelines for Diagnosis and Management of Hyperthyroidism and other Causes of Thyrotoxicosis"and"Guidelines for the Diagnosis and Management of Thyroid Nodules and Differentiated Thyroid Cancer(Second edition)",The Chinese and American guidelines have reached an agreement on the resection range of low-risk DTC with a diameter less than 1 cm and the indication of total thyroidectomy.For DTC with a diameter of 1-4 cm without high risk factors,total thyroidectomy was preferred in Chinese guidelines.In terms of neck lymph node dissection for DTC,the focus of controversy between the Chinese and American guidelines was whether to perform prophylactic central lymph node dissection for stage T1 and T2,non-invasive DTC with clinically negative lymph nodes.In addition,the Chinese guidelines have added new recommendations for endoscopic/robotic thyroid surgery.In the surgical treatment of Graves'disease hyperthyroidism,the Chinese and American guidelines have the same recommendations for preoperative preparation and surgical methods.In terms of postoperative management,the Chinese guidelines focused on the management of surgical complications,while the American guidelines recommended the postoperative hypocalcemia treatment,timing for discontinuation of antithyroid drugs,discontinuation ofβ-blockers,levothyroxine administration,and thyroid function monitoring.

关 键 词：分化型甲状腺癌 GRAVES病 指南 

分 类 号：R581[医药卫生—内分泌]