摘要
目的 了解甲状腺癌行局部剜除术或腺叶次全切除术后的腺体残癌率和颈部淋巴结转移的情况 ,明确甲状腺癌的切除范围和手术方式。方法 对 1994～ 1999年间在外院行腺叶局部切除术或次全切除术后来我院行二次手术治疗的 16 0例甲状腺癌患者进行总结 ,并对二次手术探查结果进行分析。结果 总的肿瘤残存率为 5 2 .5 % (84 / 16 0 )。原发部位残癌率为 4 2 .5 % (6 8/ 16 0 ) ,患侧颈部Ⅵ区淋巴结转移癌的发生率为 2 8.1% (45 / 16 0 ) ,患侧颈部有肿大淋巴结者的转移癌发生率为35 .4 % (34/ 96 )。外院术后患侧喉返神经损伤的发生率为 12 .5 % (2 0 / 16 0 ) ,明显高于我院二次手术所致喉返神经麻痹的发生率 1.9% (3/ 16 0 )。结论 甲状腺癌行局部剜除或腺叶次全切除术的术后残癌率较高 ,该类术式应废止。术中疑为甲状腺癌时 ,应常规行颈部Ⅵ区探查 ,必要时应行该区清扫术。甲状腺肿瘤手术操作中应重视喉返神经的解剖。
Objective To evaluati the rate of residual disease in the thy roid gland and rate of cervic al ly mph node metastasis after preliminary local resections in thy roid cancer. Methods From 1994 1999,160 thy roid cancer patients who had previously been treated with nodulectomy or subtotal lobectomy in other hospitals were reoperated. Results The rate of residual disease at the primary site was 42.5%. The ly mph node meta static rate at level Ⅵ was 28.1%. The rate of ly mph node metastasis in those wi th enlarged ly mph nodes in the ipsilateral internal jugular chain was 35.4%. The rate of lary ngeal recurrent nerve injury was 12.5% at the first operation which is mrch higher than that of the second operation (1.9%). Conclusion Because of the high rate of local residual disease, nodulectomy or subtotal lobe ctomy alone is not indicated for thy roid cancer. The exploration to level Ⅵ is needed for thy roid cancer. It is of utmost importance to be familiar with lary ng eal recurrent nerve anatomy in thy roid surgery . [
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2002年第2期185-187,共3页
Chinese Journal of Oncology
