甲状腺癌再手术147例临床分析

Outcome of reoperation for thyroid cancer：clinical analysis of 147 cases

摘要:

目的：分析分化型甲状腺癌（Differentiated thyroid carcinoma，DTC）再手术的原因，探讨DTC再手术的必要性、合理的手术方式及手术时机。方法：回顾性分析2002年1月至2009年9月重庆医科大学附属第一医院内分泌外科147例甲状腺癌再手术病人的临床资料，并结合文献讨论；再次手术方式包括：甲状腺全切术共66例；甲状腺近全切者28例；甲状腺次全切17例；一侧腺叶及对侧腺叶部分切除术2例；一侧及峡部切除术1例；腺叶切除术2例；姑息性肿块切除17例。同期行颈清扫116例，主要为改良颈清扫及中央组淋巴结清扫。结果：术后病理证实，残余甲状腺组织癌残留率65.6%（82/125），清除淋巴结组织中癌残留率62.9%（73/116），术后暂时性喉返神经损伤发生率为0.6%（1/147），暂时性低钙血症发生率为6.8%（10/147），无永久性喉返神经损伤及甲状旁腺损伤。结论：再手术原因主为首次手术方式选择及操作不当、颈淋巴结清扫不彻底或肿瘤复发，对于此类患者及早行再手术治疗是必要的，合理的再手术方式为甲状腺全切或近全切除术加改良颈淋巴清扫或中央组颈淋巴结清除。

Abstract:

Objective：To analyze the cause of reoperation for differentiated thyroid carcinoma（DTC） and to explore the time and proper surgical patterns for the reoperation. Methods：Protocols of 147 patients undergoing reoperation for thyroid cancer from January 2002 to September 2009 were reviewed retrospectively with the study considering domestic and foreign literatures. The reoperation in－cluded total thyroidectomy for 66 cases，near-total thyroidectomy for 28 cases，subtotal thyroidectomy for 17 cases，unilateral lobecto－my for 1 case and palliactive mass excision for 17 cases. Central lymph node dissection or modified neck dissection for 116 cases were performed at the same time. Results：Pathological results after reoperation confirmed that the rate of residual carcinoma in thyroid tis－sue was 65.6%（82/125） and the rate of residual in lymph node was 62.9%（28/32）. The rate of temporarily recurrent laryngeal nerve injury was 0.68%（1/147） and of temporary hypocalcaemia was 6.8%（10/147），without permanent laryngeal recurrent nerve hurt or hypocalcaemia. Conclusions：Inadequate initial operation，local recurrence and cervical lymph node metastasis of thyroid cancer need reoperation sundoubtedly. The optimal treatment is total thyroidectomy with central compartment lymph node dissection or modified neck dissection.