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背景与目的:甲状腺乳头状癌首次外科治疗常有不当,需要再次手术。我们探讨这类患者的处理原则和手术方式。方法:回顾性分析本院收治的外院已手术治疗的甲状腺乳头状癌患者132例(为了排除肿瘤局部复发因素,本组不包括在外院手术已经超过6个月以上的患者),比较手术并发症,分析原发灶局部癌肿残留及Ⅵ区淋巴结转移的临床资料。结果:原发灶局部有癌肿残留占66.7%(88/132),同时Ⅵ区淋巴结有转移的65例,Ⅵ区淋巴结转移率73.9%(65/88)。在44例原发灶未有癌残留中,Ⅵ区淋巴结转移的有34例,Ⅵ区淋巴结转移率77.3%(34/44)。原发灶局部癌肿残留+Ⅵ区淋巴结转移共有122例,占92.4%(122/132)。初次手术的并发症:声音嘶哑占3.79%(5/132)。再次手术并发症:发生声音嘶哑占1.57%(2/127)。结论:我们推荐以下处理原则:①对于甲状腺肿块术中冰冻病理诊断为恶性的,应行一侧腺叶加峡部切除。同期行Ⅵ区淋巴结清扫。②术中冰冻病理良恶性不能鉴别的情况下,应当推行腺叶切除加峡部切除;怀疑是恶性的,同期行Ⅵ区淋巴结清扫。③在行Ⅵ区淋巴结清扫中,喉返神经应常规暴露,保证Ⅵ区淋巴结的清扫彻底性。
BACKGROUND & OBJECTIVE: The first surgical treatment of thyroid papillary carcinoma is often inappropriate and requires reoperation. We explore the treatment of these patients principles and surgical approach. Methods: A retrospective analysis of 132 patients with thyroid papillary carcinoma who had undergone surgical treatment in our hospital was retrospectively analyzed. (In order to rule out the local recurrence of tumor, this group excludes patients who have undergone surgery for more than 6 months in the outpatient department.) Comparisons of surgical complications , Analysis of the primary tumor local residual tumor and Ⅵ regional lymph node metastasis clinical data. Results: There were 66.7% (88/132) residual cancer in primary tumor, 65 cases metastasized in Ⅵ lymph node and 73.9% (65/88) in Ⅵ. In 44 cases of primary tumor without residual cancer, Ⅵ area lymph node metastasis in 34 cases, Ⅵ area lymph node metastasis rate of 77.3% (34/44). There were 122 cases of primary tumor residual tumor + Ⅵ lymph node metastasis, accounting for 92.4% (122/132). Complications of primary surgery: hoarseness accounted for 3.79% (5/132). Complications again surgery: hoarseness occurred 1.57% (2/127). Conclusion: We recommend the following principles: ① thyroid surgery for frozen pathological diagnosis of malignant, should be on the side of the gland lobes and isthmus resection. Line Ⅵ lymph node dissection during the same period. ② intraoperative frozen pathological benign and malignant can not identify the case, should be the implementation of lobectomy plus isthmus resection; suspected to be malignant, the same period Ⅵ area lymph node dissection. Â ’¢ line â ... ¡area lymph node dissection, the recurrent laryngeal nerve should be routinely exposed to ensure â ... ¤ regional lymph node dissection thoroughly.