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目的就甲状腺癌主要误诊原因及再手术问题进行分析探讨。方法选择我院2010年11月~2013年11月收治的77例因甲状腺癌误诊导致再次手术患者,4例行III、Ⅳ、VI区淋巴结清扫术+政区域甲状腺近全切除术;5例行多功能保留改良性颈清扫术+甲状腺全切除术,68例行甲状腺对侧+峡部+残叶大部分切除,其中51例加做VI区淋巴结清扫。结果二次手术后,经病理证实,有35例患者出现甲状腺癌残留,癌残留率为45.5%,其中本院2例(1例为甲状腺滤泡微小乳头混和癌、1例为甲状腺滤泡癌),外院33例(均为甲状腺乳头状癌)。60例患者行改良颈淋巴结清扫术+区域性选择性颈淋巴结清扫术+中央区颈淋巴结清扫术,病理证实,有40例患者出现淋巴结转移,其中4例位于Ⅵ区、Ⅳ区、Ⅲ区,5例位于对侧VI、Ⅳ区及Ⅱ、Ⅲ、Ⅳ、Ⅵ区,31例位于VI区。随访3~41个月,无患者出现死亡、并发症、癌复发。结论国内外医学界主要采用手术方式治疗甲状腺癌,确诊为甲状腺癌后,应及时对其行甲状腺癌根治术,若只采取单纯肿瘤局部切除,则会出现癌残留,进而需再手术。
Objective To analyze the main causes of misdiagnosis and reoperation of thyroid cancer. Methods A total of 77 patients with reoperation due to misdiagnosis of thyroid cancer were enrolled in our hospital from November 2010 to November 2013. 4 patients underwent radical lymphadenectomy in III, Multi-functional preservation of modified neck dissection + total thyroidectomy, 68 cases of thyroid contralateral + isthmus + residual partial removals most of the resection, 51 cases plus lymph node dissection to do VI. Results After the second operation, pathologically, there were 35 cases of residual thyroid cancer, residual cancer rate was 45.5%, of which 2 cases of our hospital (1 case of thyroid follicular mixed papilloma, 1 case of thyroid follicular carcinoma ), Outside the hospital 33 cases (all thyroid papillary carcinoma). Sixty patients underwent modified cervical lymph node dissection + regional selective cervical lymph node dissection + central lymph node dissection. Pathology confirmed that 40 patients had lymph node metastasis, of which 4 were located in Ⅵ, Ⅳ, Ⅲ, 5 cases located in the opposite side of VI, IV and II, III, IV, VI, 31 cases in VI. Follow-up 3 to 41 months, no patient died, complications, cancer recurrence. Conclusions The surgical treatment of thyroid cancer in the medical community at home and abroad is mainly used. After the diagnosis of thyroid cancer, radical resection of thyroid cancer should be carried out in time. If only partial resection of the tumor is performed, cancer residue may occur and further surgery is required.