De Jong S A, Demeter J G, Lawrence A M, Paloyan E
Department of Surgery, Loyola University Stritch School of Medicine, Maywood, Ill.
Surgery. 1992 Oct;112(4):734-7; discussion 737-9.
The diagnosis of thyroid carcinoma during the course of lobectomy for a dominant nodule occasionally cannot be rendered on the basis of frozen section. Once the diagnosis of carcinoma is made, the question of completion thyroidectomy arises. The decision to perform completion thyroidectomy and the timing, safety, and efficacy of this procedure are reviewed.
During the past 25 years (1965 to 1990), we operated on 351 consecutive patients with thyroid carcinoma. One hundred of these patients (84 women and 16 men) were initially treated by unilateral thyroid lobectomy for the previously stated reasons. Histopathologic examination of the permanent sections of the initial thyroid lobectomy specimen demonstrated papillary carcinoma in 70 patients and follicular carcinoma in 30 patients. Within a few months, a completion thyroidectomy was performed.
The completion thyroidectomy specimen contained papillary carcinoma in 33 (47%) of the 70 patients with papillary carcinoma and 10 (33%) of the 30 patients with follicular carcinoma. Overall, 43 of these 100 patients harbored thyroid carcinoma in the contralateral lobe. Complications of completion thyroidectomy were transient recurrent nerve paresis in two patients and temporary hypoparathyroidism in three patients, requiring calcium and vitamin D therapy for a few months.
Although the significance and treatment of papillary carcinoma are debated on the basis of size and grade of the primary lesion and age and sex of the patients, once the diagnosis is made in one lobe we believe that a completion thyroidectomy should be considered, not only for papillary carcinomas but also for follicular carcinomas because 47% (papillary) to 33% (follicular) of these patients will harbor the neoplasm in the contralateral lobe.
在对甲状腺优势结节进行叶切除术的过程中，有时无法根据冰冻切片做出甲状腺癌的诊断。一旦确诊为癌，就会出现甲状腺全切术的问题。本文对甲状腺全切术的决策以及该手术的时机、安全性和疗效进行了综述。
在过去25年（1965年至1990年）间，我们连续为351例甲状腺癌患者实施了手术。其中100例患者（84名女性和16名男性）因上述原因最初接受了单侧甲状腺叶切除术。对最初甲状腺叶切除标本的永久切片进行组织病理学检查发现，70例患者为乳头状癌，30例患者为滤泡状癌。在数月内，对这些患者实施了甲状腺全切术。
在70例乳头状癌患者中，33例（47%）的甲状腺全切标本中发现对侧叶存在乳头状癌；在30例滤泡状癌患者中，10例（33%）的标本中发现对侧叶存在癌。总体而言，这100例患者中有43例对侧叶存在甲状腺癌。甲状腺全切术的并发症包括2例患者出现短暂性喉返神经麻痹，3例患者出现暂时性甲状旁腺功能减退，需要进行数月的钙和维生素D治疗。
尽管对于乳头状癌的意义和治疗存在争议，争议点在于原发灶的大小和分级以及患者的年龄和性别，但一旦在一侧叶确诊为癌，我们认为应考虑实施甲状腺全切术，不仅针对乳头状癌，也针对滤泡状癌，因为这些患者中有47%（乳头状癌）至33%（滤泡状癌）的对侧叶会存在肿瘤。
