中华内分泌外科杂志
中華內分泌外科雜誌
중화내분비외과잡지
CHINESE JOURNAL OF ENDOCRINE SURGERY
2013年
4期
278-280
,共3页
刘嘉%高新宝%苏畅%王贵民
劉嘉%高新寶%囌暢%王貴民
류가%고신보%소창%왕귀민
甲状腺癌%甲状腺切除术%颈淋巴结清扫术
甲狀腺癌%甲狀腺切除術%頸淋巴結清掃術
갑상선암%갑상선절제술%경림파결청소술
Thyroid carcinoma%Thyroidectomy%Neck dissection
目的 探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的特点及手术治疗方式.方法 回顾性分析2009年7月至2011年2月吉林大学第一医院甲状腺外科行甲状腺全切除及常规中央区淋巴结清扫的PTC 221例.结果 221例均顺利完成手术,未发生永久性医源性喉返神经损伤,1例出现永久性甲状旁腺功能减退(术后病理证实为甲状旁腺异位于甲状腺腺体内).术后病理证实为双叶癌占31.2％(69/221).甲状腺被膜浸润者占64.7％(143/221),其中双叶癌中被膜浸润占68.1％ (47/69).中央区淋巴结转移占43.0％(95/221),其中双叶癌伴中央区淋巴结转移率46.4％ (32/69),单侧癌伴中央区淋巴结转移率41.5％(63/152),浸润被膜者中央区淋巴结转移率49.7％(71/143).所有病例中被膜浸润或淋巴结转移发生率占75.6％(167/221).术后病理诊断为双侧叶PTC 69例中术前仅发现甲状腺单侧叶有可疑癌灶42例,占60.9％.结论 PTC中双叶都存在癌灶的比率很大,中央区淋巴结转移比例较高,建议绝大多数PTC患者应行甲状腺全切及中央区淋巴结常规清扫,术后辅以131 Ⅰ治疗及内分泌治疗.
目的 探討甲狀腺乳頭狀癌(papillary thyroid carcinoma,PTC)的特點及手術治療方式.方法 迴顧性分析2009年7月至2011年2月吉林大學第一醫院甲狀腺外科行甲狀腺全切除及常規中央區淋巴結清掃的PTC 221例.結果 221例均順利完成手術,未髮生永久性醫源性喉返神經損傷,1例齣現永久性甲狀徬腺功能減退(術後病理證實為甲狀徬腺異位于甲狀腺腺體內).術後病理證實為雙葉癌佔31.2％(69/221).甲狀腺被膜浸潤者佔64.7％(143/221),其中雙葉癌中被膜浸潤佔68.1％ (47/69).中央區淋巴結轉移佔43.0％(95/221),其中雙葉癌伴中央區淋巴結轉移率46.4％ (32/69),單側癌伴中央區淋巴結轉移率41.5％(63/152),浸潤被膜者中央區淋巴結轉移率49.7％(71/143).所有病例中被膜浸潤或淋巴結轉移髮生率佔75.6％(167/221).術後病理診斷為雙側葉PTC 69例中術前僅髮現甲狀腺單側葉有可疑癌竈42例,佔60.9％.結論 PTC中雙葉都存在癌竈的比率很大,中央區淋巴結轉移比例較高,建議絕大多數PTC患者應行甲狀腺全切及中央區淋巴結常規清掃,術後輔以131 Ⅰ治療及內分泌治療.
목적 탐토갑상선유두상암(papillary thyroid carcinoma,PTC)적특점급수술치료방식.방법 회고성분석2009년7월지2011년2월길림대학제일의원갑상선외과행갑상선전절제급상규중앙구림파결청소적PTC 221례.결과 221례균순리완성수술,미발생영구성의원성후반신경손상,1례출현영구성갑상방선공능감퇴(술후병리증실위갑상방선이위우갑상선선체내).술후병리증실위쌍협암점31.2％(69/221).갑상선피막침윤자점64.7％(143/221),기중쌍협암중피막침윤점68.1％ (47/69).중앙구림파결전이점43.0％(95/221),기중쌍협암반중앙구림파결전이솔46.4％ (32/69),단측암반중앙구림파결전이솔41.5％(63/152),침윤피막자중앙구림파결전이솔49.7％(71/143).소유병례중피막침윤혹림파결전이발생솔점75.6％(167/221).술후병리진단위쌍측협PTC 69례중술전부발현갑상선단측협유가의암조42례,점60.9％.결론 PTC중쌍협도존재암조적비솔흔대,중앙구림파결전이비례교고,건의절대다수PTC환자응행갑상선전절급중앙구림파결상규청소,술후보이131 Ⅰ치료급내분비치료.
Objective To investigate the biological characteristics of papillary thyroid carcinoma(PTC) and to discuss its surgical method.Methods 221 patients of PTC underwent total thyroidectomy and conventional central lymph node dissection from Jul.2009 to Feb.2011 in Department of Thyroid Surgery in the First Hospital of Jilin University.Their clinical data were retrospectively analyzed.Results There was no permanent iatrogenic injury of recurrent laryngeal nerve.Only one patient had permanent hypoparathyroidism.Postoperative pathological results showed that bilateral cancer was found in 69 cases(31.2％).Thyroid membrane invasion was found in 143 cases(64.7％),in which the invasion rate of bilateral cancer was 68.1％ (47/69).Central cervical lymph node metastasis was found in 95 cases(43％),in which central cervical lymph node metastasis rate of bilateral cancer was 46.4％ (32/69),central cervical lymph node metastasis rate of unilateral cancer was 41.5 ％ (63/152),central cervical lymph node metastasis rate of thyroid membrane invasion was 49.7％ (71/143).Thyroid membrane invasion or cervical lymph node metastasis rate in all cases was 75.6％ (167/221).There were 42 cases who were found with suspicious unilateral cancer before surgery but proved to have bilateral PTC by postoperative pathological diagnosis(60.9％).Conclusions Most PTC often occurs bilaterally and the ratio of central cervical lymph node metastasis is very high.We suggest that most patients with PTC should undergo total thyroidectomy,conventional central lymph node dissection,and combine with postoperative Ⅰ131 and hormonal treatment.
