中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2015年
1期
14-16
,共3页
甲状腺癌%手术方式%术中冰冻切片
甲狀腺癌%手術方式%術中冰凍切片
갑상선암%수술방식%술중빙동절편
Thyroid carcinoma%Surgical selection%Intraoperative fast frozen section
目的：探讨分化型甲状腺癌的诊断和手术方式。方法：对本院2010年1月-2013年12月收入院后经手术治疗的分化型甲状腺癌76例的临床资料进行回顾性分析。其中合并结节性甲状腺肿18例，甲状腺腺瘤5例，桥本氏甲状腺炎3例，原发性甲亢1例。结果：术中冰冻切片诊断68例，阳性率为89.47%。术后病理报告乳头状癌69例（90.79%），滤泡样癌7例（9.21%），伴有区域淋巴结转移47例（61.83%），肿瘤浸润包膜13例（17.11%），其中浸出包膜外9例（11.84%）。手术方式主要采取患侧腺叶、峡部切除及对侧腺叶次全切除、颈部淋巴结清扫术或甲状腺全切、颈部淋巴结清扫术。术后甲状腺功能减退5例，声音嘶哑9例（7例为暂时性，2例为永久性），7例低钙抽搐或肢端麻木。全部病例获随访，局部复发者12例，颈部淋巴结复发者5例，远处转移者3例。结论：术中冰冻切片检查有助于甲状腺癌的诊断及手术方式选择，分化型甲状腺癌应根据病理组织类型、肿瘤大小、病变范围、年龄和颈部淋巴结转移选择不同手术方式。
目的：探討分化型甲狀腺癌的診斷和手術方式。方法：對本院2010年1月-2013年12月收入院後經手術治療的分化型甲狀腺癌76例的臨床資料進行迴顧性分析。其中閤併結節性甲狀腺腫18例，甲狀腺腺瘤5例，橋本氏甲狀腺炎3例，原髮性甲亢1例。結果：術中冰凍切片診斷68例，暘性率為89.47%。術後病理報告乳頭狀癌69例（90.79%），濾泡樣癌7例（9.21%），伴有區域淋巴結轉移47例（61.83%），腫瘤浸潤包膜13例（17.11%），其中浸齣包膜外9例（11.84%）。手術方式主要採取患側腺葉、峽部切除及對側腺葉次全切除、頸部淋巴結清掃術或甲狀腺全切、頸部淋巴結清掃術。術後甲狀腺功能減退5例，聲音嘶啞9例（7例為暫時性，2例為永久性），7例低鈣抽搐或肢耑痳木。全部病例穫隨訪，跼部複髮者12例，頸部淋巴結複髮者5例，遠處轉移者3例。結論：術中冰凍切片檢查有助于甲狀腺癌的診斷及手術方式選擇，分化型甲狀腺癌應根據病理組織類型、腫瘤大小、病變範圍、年齡和頸部淋巴結轉移選擇不同手術方式。
목적：탐토분화형갑상선암적진단화수술방식。방법：대본원2010년1월-2013년12월수입원후경수술치료적분화형갑상선암76례적림상자료진행회고성분석。기중합병결절성갑상선종18례，갑상선선류5례，교본씨갑상선염3례，원발성갑항1례。결과：술중빙동절편진단68례，양성솔위89.47%。술후병리보고유두상암69례（90.79%），려포양암7례（9.21%），반유구역림파결전이47례（61.83%），종류침윤포막13례（17.11%），기중침출포막외9례（11.84%）。수술방식주요채취환측선협、협부절제급대측선협차전절제、경부림파결청소술혹갑상선전절、경부림파결청소술。술후갑상선공능감퇴5례，성음시아9례（7례위잠시성，2례위영구성），7례저개추휵혹지단마목。전부병례획수방，국부복발자12례，경부림파결복발자5례，원처전이자3례。결론：술중빙동절편검사유조우갑상선암적진단급수술방식선택，분화형갑상선암응근거병리조직류형、종류대소、병변범위、년령화경부림파결전이선택불동수술방식。
Objective: To investigate the diagnosis and surgical selection in differentiated thyroid carcinoma. Method: Clinical data of 76 differentiated thyroid carcinomas were analyzed retrospectively from January 2010 to December 2013. 18 cases were carcinoma with nodular goiter, 5 cases were carcinoma with thyroid adenoma,3 cases were carcinoma with hashimoto thyroiditis, 1 case was carcinoma with hyperthyroidism.Result:68 patients( 89.47%) were diagnosed according to intraoperative fast frozen section. 69 cases (90.79%) were approved papillary thyroid carcinoma, 7 cases (9.21%) were follicular thyroid carcinoma. Especially inside of diolame invasion in 13 patients (17.11%) and outside of diolame invasion in 9 patients (11.84%). Neck dissection was performed in 64 patients, and 47 of them( 61.83%) had cervical lymph node metastasis. The various styles of thyroidectomy were performed, 7 cases showed temporary vocal cord paralysis, 2 cases showed permanent after operation; 7 cases had convulsion or limbs numbness due to hypocalcemia, and 5 cases had thyroid function decrease. Follow up of all cases showed local recurrence in 12 patients, cervical lymph node recurrence in 5 patients and distant metastasis in 3 patients.Conclusion: Intraoperative fast frozen section is helpful for the diagnosis and the choice of operation method. The various surgical selection of thyroidectomy are performed according to the different pathological types, tumor type,pathological changes scope,age and cervical lymph node metastasis.
