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本文通过大量临床资料 ,就分化型甲状腺癌手术治疗的方式及范围进行综述及探讨。作者认为 :(1)对于原发灶的手术范围应视侵犯部位而定病变限于一侧叶 ,行患侧叶及峡叶并患侧颈前肌切除 ;若双侧叶受累 ,应力争保留部分正常腺体及后被膜下行近全甲状腺切除术 ,旨在保留甲状旁腺 ;癌限于峡叶 ,行峡叶及双侧内 1/ 3～ 1/ 2腺体及颈前肌切除 ;若癌累及腺外组织 ,在不危及生命前提下 ,应尽量切除。 (2 )颈淋巴结转移癌的外科治疗 :对于甲状腺乳头状癌 N0 期若原发癌侵出包膜 ,不行选择性颈清术 ;对于侵出包膜者行选择性颈清术。选择性颈清术的手术范围 ,作者主张重点清除气管旁及颈内静脉区。N0 期的滤泡癌不必行选择性颈清术。
This article has reviewed and discussed the methods and scope of surgical treatment of differentiated thyroid cancer through a large number of clinical data. The authors believe that: (1) The scope of surgery for primary lesions should be limited to lesions confined to one side of the leaf, the affected side of the lobe and the isthmus and ipsilateral anterior cervical muscle resection; if the bilateral leaves involved, struggle to retain part Normal thyroid gland and posterior capsule subtotal thyroidectomy to preserve the parathyroid gland; carcinoma limited to the isthmus, the vascular lobe and bilateral 1/3 to 1/2 gland and anterior cervical muscle resection; if cancer is involved Exogenous tissues should be removed as far as possible without prejudice to life. (2) Surgical treatment of cervical lymph node metastases: For primary papillary thyroid carcinoma, if primary cancer invades the capsule at N0 stage, no selective neck dissection is performed; selective neck dissection is performed for those who invade the capsule. The scope of surgery for elective cervical dissection, the author advocates to focus on the removal of paratracheal and internal jugular vein regions. N0 follicular carcinoma does not require selective neck dissection.