[甲状腺癌局部切除术后再次手术的价值]
[Value of reoperation after local resection of thyroid cancer].
作者信息
Xu Wei, Tang Pingzhang, Li Zhengjiang
机构信息
Department of Head and Neck Surgical oncology, Cancer institute Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
出版信息
Zhonghua Zhong Liu Za Zhi. 2002 Mar;24(2):185-7.
OBJECTIVE
To evaluate the rate of residual disease in the thyroid gland and rate of cervical lymph node metastasis after preliminary local resections in thyroid cancer.
METHODS
From 1994 - 1999, 160 thyroid 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 lymph node metastatic rate at level VI was 28.1%. The rate of lymph node metastasis in those with enlarged lymph nodes in the ipsilateral internal jugular chain was 35.4%. The rate of laryngeal recurrent nerve injury was 12.5% at the first operation which is much higher than that of the second operation (1.9%).
CONCLUSION
Because of the high rate of local residual disease, nodulectomy or subtotal lobectomy alone is not indicated for thyroid cancer. The exploration to level VI is needed for thyroid cancer. It is of utmost importance to be familiar with laryngeal recurrent nerve anatomy in thyroid surgery.
目的
评估甲状腺癌初次局部切除术后甲状腺残余疾病发生率及颈部淋巴结转移率。
方法
1994年至1999年，对160例曾在其他医院接受过结节切除术或次全叶切除术的甲状腺癌患者进行再次手术。
结果
原发部位残余疾病发生率为42.5%。Ⅵ区淋巴结转移率为28.1%。同侧颈内静脉链淋巴结肿大患者的淋巴结转移率为35.4%。首次手术时喉返神经损伤率为12.5%，远高于二次手术（1.9%）。
结论
由于局部残余疾病发生率高，甲状腺癌不宜单独行结节切除术或次全叶切除术。甲状腺癌手术需要探查Ⅵ区。熟悉甲状腺手术中喉返神经的解剖结构至关重要。
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