CAJ | 학술논문

目的探讨甲状腺微小癌(TMC)手术方式的临床价值以及对患者术后的影响.方法回顾性分析2009年2月至2012年2月西山煤电集团职工总医院收治的病理明确诊断为甲状腺微小癌89例患者的临床资料,所有患者均经手术切除且术后常规终身服用甲状腺素以抑制促甲状腺激素(TSH),并定期复查甲状腺激素游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、TSH值来调节用药量,使FT3、FT4稍高于正常,TSH稍低于正常.记录其年龄、性别、联系方式、病灶数量和病灶所在部位、淋巴结转移情况、手术方式、病理结果及术后治疗,并进行比较.结果患侧腺叶+峡部+对侧腺叶次全切除复发转移率分别与患侧腺叶部分切除和患侧腺叶+加峡部切除比较,差异均有统计学意义(P＜0.05).双叶甲状腺次全切与双叶甲状腺全切除复发转移率比较,差异无统计学意义(P＞0.05).预防性清扫复发转移率为3.6％,未行预防性清扫复发转移率为4.1％,两者比较差异无统计学意义(P＞0.05).结论甲状腺微小癌的最佳手术方式是:①单侧的TMC患者应行甲状腺近全切除,即患侧腺叶+峡部+对侧腺叶次全切除.②双侧多灶癌的TMC患者应行双叶甲状腺次全切或双叶甲状腺全切除.③如第一次手术切除范围不足上述范围,应行二次手术.对无颈淋巴结转移的TMC患者不行预防性颈部淋巴清扫.但对有局部淋巴结转移的TMC患者,应加行功能性颈部淋巴结清扫术.
목적 탐토갑상선미소암(TMC)수술방식적림상개치이급대환자술후적영향.방법 회고성분석2009년2월지2012년2월서산매전집단직공총의원수치적병리명학진단위갑상선미소암89례환자적림상자료,소유환자균경수술절제차술후상규종신복용갑상선소이억제촉갑상선격소(TSH),병정기복사갑상선격소유리삼전갑상선원안산(FT3)、유리갑상선격소(FT4)、TSH치래조절용약량,사FT3、FT4초고우정상,TSH초저우정상.기록기년령、성별、련계방식、병조수량화병조소재부위、림파결전이정황、수술방식、병리결과급술후치료,병진행비교.결과 환측선협+협부+대측선협차전절제복발전이솔분별여환측선협부분절제화환측선협+가협부절제비교,차이균유통계학의의(P＜0.05).쌍협갑상선차전절여쌍협갑상선전절제복발전이솔비교,차이무통계학의의(P＞0.05).예방성청소복발전이솔위3.6％,미행예방성청소복발전이솔위4.1％,량자비교차이무통계학의의(P＞0.05).결론 갑상선미소암적최가수술방식시:①단측적TMC환자응행갑상선근전절제,즉환측선협+협부+대측선협차전절제.②쌍측다조암적TMC환자응행쌍협갑상선차전절혹쌍협갑상선전절제.③여제일차수술절제범위불족상술범위,응행이차수술.대무경림파결전이적TMC환자불행예방성경부림파청소.단대유국부림파결전이적TMC환자,응가행공능성경부림파결청소술.
Objective To investigate the clinical value of the thyroid micro-carcinoma (TMC) surgical approach and the effect of surgery on the prognosis of patients.Methods The clinical data of 89 cases of TMC underwent surgery from February 2009 to February 2012 were retrospectively analyzed.All cases were confirmed by surgical resection and given postoperative conventional lifelong thyroxin suppression of TSH,and the FT3,F-T4 and TSH values were periodicly reviewed to adjust the dosage,so that FI3 and FT4 values were slightly higher than normal value,TSH value was slightly lower than normal value.Their age,gender,contact information,number of lesions and the location of lesions,lymph node metastasis,surgical approach,pathological findings and postoperative treatment was recorded and compared.Results The rate of recurrence or metastasis of ipsilateral gland + isthmus + contralateral gland subtotal resection was higher than that in the ipsilateral gland resection and ipsilateral gland + plus isthmus resection (P ＜ 0.05).There was no significant difference in the rate of recurrence or metastasis between futaba thyroid subtotal and double leaf total thyroidectomy (P ＞ 0.05).There was also no significant difference in the rate of recurrence or metastasis between preventive cleaning and prophylactic cleaning (P ＞ 0.05).Conclusions The best surgical approach for thyroid micro-carcinoma:①The TMC patients with unilateral thyroid near total resection of the ipsilateral gland leaf + isthmus + contralateral lobe and subtotal resection.②Bilateral multifocal TMC patients with cancer should be fit to the futaba subtotal thyroidectomy cut or double leaf thyroid total resection.③If the extent of surgical resection for the first time less than the above range,the second operation should be given.TMC patients with cervical lymph node metastasis,no prophylactic neck dissection.TMC patients with regional lymph node metastasis should be added to the line of functional cervical lymph node dissection.