Ardito G, Revelli L, Tosti F, Modugno P, Giacinto O, Praquin B, Ardito F, Moschella F
Istituto di Semeiotica Chirurgica, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma.
Rays. 2000 Apr-Jun;25(2):199-206.
Surgery of differentiated thyroid carcinoma is burdened with risk factors that significantly impact on prognosis, as age at diagnosis and tumor stage. Problems involved concern the extent of surgical resection and the indication for regional lymphadenectomy. As for the former, the most popular approach is total thyroidectomy "on principle" with neck lymphadenectomy. Lobectomy may represent an alternative to total thyroidectomy in low risk patients with unifocal papillary carcinoma 1 cm or less in size, or minimally invasive follicular carcinoma. As for lymphadenectomy, most authors do not agree with surgery "on principle" but rather "of necessity", that is, in presence of clinically evident lymphadenopathy and neck lymphadenectomy is the preferred surgical strategy. In most cases surgery is the treatment of choice of locoregional recurrence. Careful preoperative work-up and accurate surgical procedure are mandatory.
分化型甲状腺癌手术存在一些显著影响预后的风险因素，如诊断时的年龄和肿瘤分期。相关问题涉及手术切除范围和区域淋巴结清扫的指征。就前者而言，最常用的方法是“原则上”行全甲状腺切除术并进行颈部淋巴结清扫。对于直径1厘米及以下的单灶性乳头状癌或微小浸润性滤泡癌的低风险患者，甲状腺叶切除术可能是全甲状腺切除术的替代方案。至于淋巴结清扫，大多数作者不赞同“原则上”进行手术，而是主张“必要时”进行，即存在临床明显的淋巴结病时，颈部淋巴结清扫是首选的手术策略。在大多数情况下，手术是局部区域复发的首选治疗方法。术前仔细评估和精确的手术操作是必不可少的。
