CAJ | 학술논문

目的探讨分化型甲状腺癌的诊治方法选择.方法我院2002年2月至2008年1月收治78例分化型甲状腺癌患者,均给予手术治疗,根据肿瘤大小、病灶数量、颈部淋巴结转移和年龄选择不同术式.单侧分化型甲状腺癌行患侧甲状腺及峡部切除或加对侧甲状腺部分切除术;双侧者行甲状腺全切或近全切除术;高危患者(年龄>45岁,肿瘤>4 cm,肿瘤≤4 cm但超出甲状腺包膜)行颈淋巴结清扫术,术后辅以内分泌治疗.患侧腺叶+峡部切除术11例,患侧腺叶+峡部切除术+对侧腺体部分切除术19例,甲状腺近全切除术26例,双侧甲状腺全切除术22例;功能性颈淋巴结清扫术25例,中央区(Ⅵ区)颈淋巴结清扫术23例.结果乳头状癌68例(87.18%),滤泡状癌10例(12.82%);中央区淋巴结转移26例.术后并发症:短期低钙手足麻木12例(15.38%),暂时性喉返神经麻痹8例(10.26%),永久性声音嘶哑2例(2.56%),乳糜漏3例(3.85%).74例获随访,随访率为94.87%,随访6个月～6年.6例局部复发淋巴结转移,经再次手术切除,无远处转移.生存率97.30%(72/74).结论肿瘤大小、病灶数量、颈部淋巴结转移和年龄应作为分化型甲状腺癌手术方式选择的依据,对于高危患者应常规行中央区淋巴结清扫.
목적 탐토분화형갑상선암적진치방법 선택.방법 아원2002년2월지2008년1월수치78례분화형갑상선암환자,균급여수술치료,근거종류대소、병조수량、경부림파결전이화년령선택불동술식.단측분화형갑상선암행환측갑상선급협부절제혹가대측갑상선부분절제술;쌍측자행갑상선전절혹근전절제술;고위환자(년령>45세,종류>4 cm,종류≤4 cm단초출갑상선포막)행경림파결청소술,술후보이내분비치료.환측선협+협부절제술11례,환측선협+협부절제술+대측선체부분절제술19례,갑상선근전절제술26례,쌍측갑상선전절제술22례;공능성경림파결청소술25례,중앙구(Ⅵ구)경림파결청소술23례.결과 유두상암68례(87.18%),려포상암10례(12.82%);중앙구림파결전이26례.술후병발증:단기저개수족마목12례(15.38%),잠시성후반신경마비8례(10.26%),영구성성음시아2례(2.56%),유미루3례(3.85%).74례획수방,수방솔위94.87%,수방6개월～6년.6례국부복발림파결전이,경재차수술절제,무원처전이.생존솔97.30%(72/74).결론 종류대소、병조수량、경부림파결전이화년령응작위분화형갑상선암수술방식선택적의거,대우고위환자응상규행중앙구림파결청소.
Objective To investigate the differentiated thyroid carcinoma diagnosis and treatment options. Methods From Feb. 2002 to Jan. 2008,78 patients received different surgical resection regarding the type of tumor size,number of tumor,ages and jugular lymphatic metastasis. Patients with unilateral differentiated thyroid carcinoma underwent the resection of ipsilateral isthmus of thyroid lobe or plus partial contralateral gland,and those with bilateral-lobe underwent total thyroidectomy or near-total thyroidectomy. High-risk patients (age >45 years,tumor size >4 cm,tumor size ≤4 cm,but surpass the envelop of thyroid) were performed by functional neck dissection or lymph node dissection of central region (Ⅵ area) besides postoperative endocrine therapy. Results Eleven cases underwent the resection of ipsilateral lobe with isthmus, 19 cases underwent surgical removal of ipsilateral lobe with isthmus plus partial contralateral gland,26 cases underwent near-total thyroidectomy and 22 total thyroidectomy. 25 cases underwent functional neck dissection, 23 cases underwent neck dissection of central region. There were 68 papillary thyroid carcinoma (87. 18%), 10 follicular thyroid carcinoma (12. 82%). There were 26 cases with lymphatic metastasis of Ⅵ area. Postoperative complications included 12 cases (15.38%) with deadlimb caused by hypocalcemia, 8 cases (10.26%) with transient recurrent nerve paralysis,2 cases (2.56%) with permanent injury of recurrent laryngeal nerves, 3 cases (3. 58%) with chylous fistula. Seventy-four(94. 87%) cases were followed up postoperatively for a period from 6 months to 6 years,which showed that no death occurred,but 6 relapsed with jugular lymphatic metastasis,after reoperation no distant metastasis occurred. Survival rate was 97. 30% (72/74). Conclusion Treatment of the differentiated thyroid carcinoma should be based on the size of tumor,number of tumor,age and jugular lymphatic metastasis. Lymph node dissection of central region was necessary for high-risk patients of differentiated thyroid carcinoma.