CAJ | 학술논문

目的探讨双侧甲状腺癌的诊断和治疗方法.方法回顾性分析68例双侧甲状腺癌的临床资料.结果行甲状腺全切+双侧功能性清扫22例,全切+单侧功能性清扫30例,全切+Ⅵ区淋巴结清扫14例,姑息性手术2例.12例术后131I治疗.术后并发症:5例单侧短暂喉返神经麻痹;1例双侧永久性喉返神经损伤经气管切开,带管生存;1例气管软化,窒息,经气管切开,带管生存;6例短暂低血钙抽搐;1例永久性甲状旁腺功能低下;2例术后乳糜瘘,1例手术缝扎治愈,1例保守治疗治愈.术前B超均发现甲状腺内实性或囊实性低回声结节,结节内有钙化38例(55.88%);针吸细胞学确诊42例,术中快速病理证实64例(94.12%).63例获随访,随访率为92.64%,随访6个月至5年,5例复发转移,经再次手术切除,除1例未分化癌术后6个月死亡,余均存活.结论甲状腺全切+颈部淋巴清扫是双侧甲状腺癌的主要术式,术前高频B超提示甲状腺结节内微钙化灶对术前诊断有重要意义.
목적 탐토쌍측갑상선암적진단화치료방법.방법 회고성분석68례쌍측갑상선암적림상자료.결과 행갑상선전절+쌍측공능성청소22례,전절+단측공능성청소30례,전절+Ⅵ구림파결청소14례,고식성수술2례.12례술후131I치료.술후병발증:5례단측단잠후반신경마비;1례쌍측영구성후반신경손상경기관절개,대관생존;1례기관연화,질식,경기관절개,대관생존;6례단잠저혈개추휵;1례영구성갑상방선공능저하;2례술후유미루,1례수술봉찰치유,1례보수치료치유.술전B초균발현갑상선내실성혹낭실성저회성결절,결절내유개화38례(55.88%);침흡세포학학진42례,술중쾌속병리증실64례(94.12%).63례획수방,수방솔위92.64%,수방6개월지5년,5례복발전이,경재차수술절제,제1례미분화암술후6개월사망,여균존활.결론 갑상선전절+경부림파청소시쌍측갑상선암적주요술식,술전고빈B초제시갑상선결절내미개화조대술전진단유중요의의.
Objective To investigate the diagnosis and treatment of bilateral thyroid carcinoma(BTC).Methods Clinical data of 68 cases with BTC from July 2001 to July 2008 were analyzed retrospectively.Results All patients underwent surgical treatment.22 cases received total thyroidectomy and bilateral functional neck dissection,30 cases received total thyroidectomy and unilateral functional neck dissection,14 cases received total thyroidectomy and lymph node dissection of Ⅵ area,2 cases received palliative resection.12 cases received proper radioactive 131I therapy after operation.Postoperative complications occured in 16 cases,including 5 cases with transient recurrent nerve paralysis,1 case with permanent injury of recurrent laryngeal nerves received trachea incision,1 case with tracheomalacia and asphyxia,6 cases with convulsion caused by hypocalcemia,1 case with permanent hypoparathyroidism,2 cases with chylous fistula(one was cured by saturing and ligaturing and the other by conservative treatment).Low echo solid or cystic solid nodules in thyroid were found by preoperative ultrasonic scan in all cases,in which 38(55.88%)cases were associated with gravel calcified lesion in thyroid nodules.The diagnosis was comfirmed by needle aspiration biopsy(NAB)in 42 cases preoperatively and 64 cases(94.12%)by frozen section intraoperatively.63(92.64%)cases were followed up postoperatively for a period from 6 months to 5 years,all 5 cases with recurrence and/or metastasis had tumor-free survival after reoperation except for 1 case with undifferentiated cancer died on the 6th month after operation.Conclusions Total thyroidectomy and lymph node dissection is essential to the treatment of BTC.Gravel calcified lesion revealed by preoperative high frequency ultrasonagraphy is an important characteristic for preoperative diagnosis of thyroid cancer.