分化型甲状腺癌再次手术57例临床分析

目的:分析分化型甲状腺癌再次手术原因,探讨甲状腺癌首次及再次手术合理方式。方法:回顾性分析2008年3月—2012年8月收治的57例甲状腺癌再次手术患者的临床资料。再次手术方式为残留甲状腺全切并中央区淋巴结清除,根据术中病理检查结果确定是否行颈侧区淋巴结清除或功能性颈淋巴结清除术。结果:术后石蜡切片病理证实,腺体肿瘤残留率51.2%(22/43),转移淋巴结残留率57.9%(33/57)。术后暂时性和永久性喉返神经损伤发生率分别为5.3%(3/57)及1.8%(1/57)。暂时性甲状旁腺损伤发生率为14.0%(8/57),无永久性甲状腺旁腺损伤。结论:对怀疑有肿瘤残留或复发的分化型甲状腺癌术后患者应再次手术,手术方式应予残余甲状腺切除并中央区淋巴结清除和(或)颈侧区淋巴结清除,首次手术确诊为分化型甲状腺癌患者最好行甲状腺全切并中央区淋巴结清除术,或加行颈侧区淋巴结清除术。

Clinical analysis for 57 re-operational cases of differentiated thyroid cancer

Objective：To analyze re-operational reasons of differentiated thyroid cancer （DTC） and discuss rational method of first and second operation for DTC.Method：57 cases of second operation of DTC from March 2008 to August 2012 were retrospectively reviewed,All cases underwent total thyroidectomy and excision of central cervical lymph nodes,those with central positive lymph nodes underwent excision of lateral cervical lymph nodes further more,those with lateral positive lymph nodes underwent functional neck dissection.Result：The residual rate of cancer in thyroids and lymph nodes were 51.2％ and 57.9％ respectively,temporary and unrecoverable injury rate of recurrent laryngeal nerve were 5.3％ and 1.7％,temporary injury rate of parathyroid was 14.0％.Conclusion：Total thyroidectomy and dissection of central/lateral cervical lymph nodes is rational operation for patients of DTC if they are suspected to have residual or recurrent tumor,it is better to undertake total thyroidectomy and dissection of central/lateral cervical lymph nodes for DTC patients when undergoing first operation.