近几十年来,甲状腺癌外科手术的范围历经变迁起伏。五十年代以前,由于一般仅做肿瘤局部摘除,死于复发者甚多。有鉴于此,随后一阶段中,多倾向于强调手术的根治性。除双侧甲状腺全切除外,为了颈淋巴结的彻底清扫,包括颈前肌、胸锁乳突肌及颈内静脉在内的所谓“颈大块切除”风行一时。随着对各种甲状腺癌生物学特性的进一步认识,同时因根治性颈清扫常明显地损害了患者的外观,有时可有严重的并发症、病残,甚至死亡。因此,近十余年来又倾向于根据具体病例制订合理的手术范围。事实上,在甲状腺癌的总称下,包括一系列具有不同生物学特性的病变。例如.在男性小于40岁,女性小于50岁的乳头状甲状腺癌患者中,治愈率极高,而 In recent decades, the scope of thyroid cancer surgery has undergone changes. Before the 1950s, due to the general removal of only local tumors, many people died of relapse. In view of this, in the subsequent stage, many tend to emphasize the radical nature of surgery. In addition to bilateral total thyroidectomy, so-called “cervical bulk resection”, including the anterior cervical, sternocleidomastoid, and internal jugular veins, has become popular for the thorough dissection of cervical lymph nodes. With further understanding of the biological characteristics of various thyroid cancers, at the same time, radical neck dissection often significantly impairs the appearance of patients, sometimes with severe complications, disability, and even death. Therefore, in the past decade or so, it has tended to formulate a reasonable scope of surgery based on specific cases. In fact, under the general name of thyroid cancer, it includes a series of lesions with different biological characteristics. For example, in the case of papillary thyroid cancer in men less than 40 years old and women less than 50 years old, the cure rate is extremely high.