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目的探讨分化型甲状腺癌再次手术的手术方式及手术技巧。方法回顾性分析2011年2月至2013年2月期间解放军总医院普通外科及解放军总医院第一附属医院普通外科收治的56例分化型甲状腺癌再次手术患者的临床资料。结果所有患者均成功完成再次手术,手术时间90~150 min,平均120 min;术中出血量70~200 mL,平均120 mL;术后引流量90~210 mL,平均100 mL。44例患者再次手术后的病理学检查结果与第一次术后病理学检查结果相同,其余12例切除腺体中未见恶性肿瘤组织。所有患者术后均无出血和饮水呛咳发生。术后8例出现手足麻木,5例出现短暂性声音嘶哑。术后50例患者获访,随访率为89.3%(50/56),随访时间为再次手术后6~30个月,平均10.8个月;首次手术后18~66个月,平均45.2个月。随访期间,1例乳头状癌患者死于术后44个月,1例滤泡状癌患者死于术后38个月;3例发生患侧非Ⅵ区淋巴结转移;均无复发。结论对于分化型甲状腺癌患者,再次手术前需要进行全身评估,选择合理的再次手术术式,术中通过使用喉返神经监测、纳米碳标记待清扫淋巴结、保护甲状旁腺等措施,降低再次手术术后并发症的发生率,提高生存率,并改善生活质量。
Objective To investigate the surgical methods and surgical techniques of reoperation for differentiated thyroid cancer. Methods The clinical data of 56 patients with differentiated thyroid cancer undergoing reoperation from January 2011 to February 2013 in General Surgery General Hospital of PLA General Hospital and the First Affiliated Hospital of PLA General Hospital were retrospectively analyzed. Results All patients underwent reoperation successfully. The operation time was 90-150 min (mean 120 min). The blood loss was 70-200 mL (average 120 mL). The drainage volume was 90-210 mL (average 100 mL). Forty-four patients had the same histopathological findings after reoperation as the first postoperative pathological examination, and the remaining 12 resected glands showed no malignant tumor tissue. No bleeding and drinking cough occurred in all patients after operation. 8 cases of hand and foot numbness after surgery, 5 cases of transient hoarseness. Fifty patients were followed up at a rate of 89.3% (50/56). The follow-up time ranged from 6 months to 30 months after reoperation (average 10.8 months). The first postoperative operation was 18 to 66 months (average 45.2 months). During the follow-up period, one patient with papillary carcinoma died of a postoperative 44 months. One patient with follicular carcinoma died of an operation of 38 months after operation. Three patients developed non-Ⅵ lymph node metastasis. No recurrence occurred. Conclusion For patients with differentiated thyroid cancer, the need for systemic reassessment before surgery again, select a reasonable reoperation surgery, surgery through the use of laryngeal nerve monitoring, nano-carbon markers to be cleared lymph nodes, parathyroid protection measures to reduce reoperation The incidence of postoperative complications, increased survival, and improved quality of life.