摘要
目的探讨甲状腺癌再次补充根治手术的原因及手术策略。方法回顾性分析2020年1月至2022年7月期间在贵州省人民医院实施补充甲状腺癌根治手术的35例甲状腺癌患者的临床资料。结果35例患者中女23例,男12例;年龄17~68岁(中位数为42岁)。22例患者初次手术前细针穿刺细胞学检查或术中冰冻病理学检查提示甲状腺结节未定性,术后病理学检查提示为甲状腺癌;11例患者初次手术后的病理学检查提示存在大量(>5个)中央区淋巴结(central lymph nodes,CLN)转移,2例患者为甲状腺髓样癌。35例患者均在初次手术后5~93 d行补充手术,其中3例患者行患侧残余腺叶及峡部切除±同侧CLN清扫,18例患者行对侧腺叶切除+CLN清扫,14例患者行对侧腺叶切除+患侧颈侧区(Ⅲ~Ⅳ区)淋巴结清扫。手术时间为45~135 min(中位数为105 min),术中出血量为10~50 mL(中位数为20 mL)。术后1例患者出现暂时性喉返神经损伤,术后5个月声音恢复正常;6例患者出现暂时性甲状旁腺功能减退,予对症处理1~3个月后血清甲状旁腺激素恢复正常水平。19例患者行术后碘-131治疗,术后随访观察1~16个月(中位数为12个月),未见肿瘤复发或转移征象。结论术前及术中对甲状腺结节进行精确的诊断评估并进行规范的手术能够减少补充手术的发生。对于确需补充甲状腺手术的患者,围手术期需进行充分的医患沟通,及早采取应对措施并选择恰当的手术方式,可以避免术后肿瘤早期复发,改善患者生存状况。
Objective To explore the causes and surgical strategies of completion thyroidectomy for thyroid cancer.Method The clinical data of 35 patients with thyroid cancer who underwent completion thyroidectomy in Guizhou Provincial People’s Hospital from January 2020 to July 2022 were analyzed retrospectively.Results There were 23 females and 12 males,aged from 17 to 68 years(median 42 years).The nature of thyroid nodules in 22 patients was not determined at preoperative fine needle aspiration cytology or intraoperative frozen pathological examination,but the paraffin section examination after operation indicated thyroid cancer.Pathological examination after the first operation showed that 11 patients had a large number of lymph node metastasis in the central area(more than 5),and 2 patients were confirmed as medullary thyroid carcinoma.All the 35 patients underwent completion thyroidectomy at 5–93 days after the initial operation,among which 3 patients underwent resection of the affected side residual glandular lobe and isthmus±ipsilateral CLN dissection,18 patients underwent contralateral lobectomy and CLN cleaning,and 14 patients underwent contralateral lobectomy and lymph node dissection of the affected side cervical region(Ⅲ–Ⅳregion).The operative time was 45–135 min(median 105 min).Intraoperative blood loss was 10–50 mL(median 20 mL).One patient suffered from temporary recurrent laryngeal nerve injury after operation,and voice had returned to normal at 5 months after operation.Six patients showed temporary hypoparathyroidism,and serum parathyroid hormone returned to normal level in 1–3 months after symptomatic treatment.Nineteen patients were treated with iodine-131 after operation,and were followed-up for 1–16 months(median 12 months).No signs of tumor recurrence or metastasis were found.Conclusions Accurate preoperative and intraoperative evaluation of thyroid nodules and standardized surgery can reduce the incidence of completion thyroidectomy.For patients who really need completion thyroidectomy,adequate doctor-patient communication during the perioperative period,early response measures and appropriate completion thyroidectomy can reduce the probability of postoperative tumor recurrence and improve the survival of patients.
作者
翟宝伟
李彪
余招焱
ZHAI Baowei;LI Biao;YU Zhaoyan(Department of Vascular and Thyroid Surgery,Guizhou Provincial People’s Hospital,Guiyang 550002,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2023年第10期1239-1243,共5页
Chinese Journal of Bases and Clinics In General Surgery
基金
贵州省科技计划项目[项目编号:黔科合基础(2020)1Y290号]。
关键词
甲状腺癌
补充甲状腺手术
颈淋巴结转移
术中冰冻病理学检查
thyroid cancer
completion thyroidectomy
cervical lymph node metastasis
intraoperative frozen pathological examination
