论文部分内容阅读
[目的]探讨分化型甲状腺癌不同术式术后残癌率和颈部淋巴结转移情况。[方法]对在外院行不同术式治疗后来我院行二次手术的共147例分化型甲状腺癌患者进行总结分析。147例均行患侧侧颈淋巴结探查活检,如冰冻证实淋巴结转移,则行侧颈功能性颈部淋巴结清扫。[结果]再次术式:行患侧甲状腺残叶切除134例,行患侧Ⅵ区淋巴结清扫125例。总的残癌率为26.53%(39/147),行肿物切除的残癌率为34.00%(17/50),行部分切除的残癌率为34.78%(16/46),行次全切除的残癌率为15.79%(6/38),行腺叶切除的13例患者未见明确癌残留。患侧Ⅵ区淋巴结总转移率50.4%(63/125)。侧方淋巴结总转移率42.86%(63/147),且侧方淋巴结转移与原发灶肿瘤外侵相关(P<0.05)。因初次手术引起的声带麻痹率为9.52%(14/147)。[结论]分化型甲状腺癌行局部切除术后肿瘤残留率高,应尽可能避免该术式应用。部分切除后补充手术是必要的。对分化型甲状腺癌处理,需至少行患侧腺叶加峡部加同侧Ⅵ区淋巴结清扫,同时探查患侧侧颈淋巴结,根据冰冻结果决定是否清扫。
[Objective] To investigate the postoperative residual cancer rate and cervical lymph node metastasis in differentiated thyroid cancer patients under different surgical procedures. [Methods] A total of 147 cases of differentiated thyroid cancer patients undergoing secondary surgery in our hospital after different surgical treatment were summarized. 147 patients underwent ipsilateral cervical lymph node biopsy, such as frozen confirmed lymph node metastasis, neck lateral cervical lymph node dissection. [Results] Reoperational procedure: 134 cases of residual thyroid gland lobectomy were performed, and 125 cases of lymphadenectomy of Ⅵ in ipsilateral. The total residual cancer rate was 26.53% (39/147). The rate of residual cancer was 34.00% (17/50) after resection and 34.78% (16/46) with partial resection. The resected residual cancer rate was 15.79% (6/38). No clear cancer residue was found in 13 patients who underwent lobectomy. The ipsilateral Ⅵ area lymph node metastasis rate was 50.4% (63/125). The rate of lateral lymph node metastasis was 42.86% (63/147), and the lateral lymph node metastasis was related to the primary tumor invasion (P <0.05). Vocal cord paralysis due to initial surgery was 9.52% (14/147). [Conclusion] The residual rate of tumor after partial resection of differentiated thyroid carcinoma is high, so it should be avoided as far as possible. Partial resection after surgery is necessary. For differentiated thyroid cancer treatment, at least the ipsilateral lobular plus isthmic plus ipsilateral Ⅵ regional lymph node dissection, at the same time to explore the affected side of the neck lymph nodes, according to the results of the freezing to decide whether to clean.