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目的总结二次手术的时机、方法、术中注意事项及疗效。方法回顾性分析我院普外科2002年1月至2008年12月分化型甲状腺癌二次手术18例。结果术前针吸活检报告甲状腺瘤12例,术中快速冰冻切片报告腺瘤样增生及腺瘤各1例,术前及术中无病理检查4例。二次手术方法:患侧残留腺体切除,峡部加对侧次全切除加中央区淋巴结清扫8例,改良颈清扫10例。喉返神经损伤致声音嘶哑1例。5年生存率94%(17/18)。结论二次手术时机在1周以内较好。术中注意保护血管、神经、甲状旁腺。二次手术可取得很好的治疗效果。
Objective To summarize the timing, method, intraoperative precautions and curative effect of secondary surgery. Methods Retrospective analysis of 18 cases of differentiated thyroid cancer secondary surgery in our hospital from January 2002 to December 2008. Results Preoperative needle aspiration biopsy reported thyroid tumor in 12 cases, rapid intraoperative frozen section reported adenoma-like hyperplasia and adenoma in 1 case, no preoperative and intraoperative pathological examination in 4 cases. Secondary surgery: ipsilateral residual gland resection, isthmic plus contralateral subtotal plus central lymph node dissection in 8 cases, improved neck dissection in 10 cases. Recurrent laryngeal nerve injury caused by hoarseness in 1 case. 5-year survival rate of 94% (17/18). Conclusion The timing of second surgery is better within 1 week. Intraoperative attention to the protection of blood vessels, nerves, parathyroid. Second surgery can achieve good therapeutic effect.