甲状腺微小癌手术方式的研究探讨
Study of the surgical approach of thyroid microcarcinoma
崔建兵 1史俊涛 1张叶锋1
作者信息
- 1. 030053 太原,山西省西山煤电集团职工总医院普外科
- 折叠
摘要
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.
Abstract
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.
关键词
甲状腺微小癌/手术方式/术后治疗Key words
Thyroid micro carcinoma/Surgical approach/Postoperative treatment引用本文复制引用
出版年
2014
NETL
NSTL
维普
万方数据