Dewil B, Van Damme B, Vander Poorten V, Delaere P, Debruyne F
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Belgium.
B-ENT. 2005;1(2):67-72.
The optimal surgical management of well-differentiated thyroid cancer (DTC) remains a controversial topic. Preoperative and peroperative investigations quite frequently fail to detect thyroid cancer in cold nodules, and only postoperative histological examination reveals malignancy. In these cases many physicians perform a completion thyroidectomy. Others recommend a conservative approach with close follow-up because of the increased risk of complications after re-operation. In our department, routine management includes completion thyroidectomy once the histopathological report concludes that there is carcinoma, except in cases of papillary carcinoma measuring less than 1 cm. The aim of our study was to determine the incidence of contralateral malignancy and of complications after completion thyroidectomy. We reviewed the records of 29 patients--25 women and 4 men-- who all underwent completion thyroidectomy because of an unexpected diagnosis of DTC. Residual malignancy was found in 12 patients (41.4%) after completion thyroidectomy. In ten patients (34.5%) the malignancy was localised in the contralateral lobe and two patients (6.9%) had lymph node metastases. Postoperative transient hypocalcaemia (< 8.0 mg/dl) occurred in five patients (17.2%) and permanent hypocalcaemia (lasting longer than 6 months) was a feature in two patients. One patient suffered transient laryngeal nerve injury occurred in one patient and there were no permanent lesions. In conclusion, we found residual DTC in 41.4% of patients undergoing reintervention. Because of the rather low re-operation rate, we prefer to perform a completion thyroidectomy to remove potential occult malignancy and to allow for postoperative 131I-treatment in all patients with a diagnosis of malignancy in their thyroid lobectomy specimen, with the exception of papillary carcinoma < 1 cm.
高分化甲状腺癌（DTC）的最佳手术治疗方案仍是一个有争议的话题。术前和术中检查常常无法在冷结节中检测出甲状腺癌，只有术后组织学检查才能发现恶性病变。在这些情况下，许多医生会进行甲状腺全切术。另一些人则建议采用保守方法并密切随访，因为再次手术后并发症风险增加。在我们科室，常规治疗方案是一旦组织病理学报告确诊为癌，便进行甲状腺全切术，但直径小于1cm的乳头状癌除外。我们研究的目的是确定甲状腺全切术后对侧恶性肿瘤的发生率和并发症情况。我们回顾了29例患者的记录，其中25名女性和4名男性，他们均因意外诊断为DTC而接受了甲状腺全切术。甲状腺全切术后，12例患者（41.4%）发现有残留恶性肿瘤。10例患者（34.5%）的恶性肿瘤位于对侧叶，2例患者（6.9%）有淋巴结转移。5例患者（17.2%）术后出现短暂性低钙血症（血钙<8.0mg/dl），2例患者有永久性低钙血症（持续时间超过6个月）。1例患者发生短暂性喉返神经损伤，无永久性病变。总之，我们发现再次手术的患者中有41.4%存在残留DTC。由于再次手术率相当低，我们更倾向于进行甲状腺全切术，以切除潜在的隐匿性恶性肿瘤，并允许对所有甲状腺叶切除标本诊断为恶性肿瘤的患者进行术后131I治疗，但直径<1cm的乳头状癌除外。
