Gimm O, Dralle H
Universitäts- und Poliklinik für Allgemein-, Viszeral- und Gefässchirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale.
Chirurg. 2007 Mar;78(3):182, 184-8, 190-3. doi: 10.1007/s00104-007-1303-y.
In general, primary surgery of thyroid carcinoma should consist of total thyroidectomy and lymph node dissection of the cervicocentral compartment. Exceptions are cases of papillary microcarcinoma and prophylactic surgery due to multiple type 2A endocrine neoplasia. Lymph node dissection beyond the cervicocentral compartment also should be compartment-oriented. It is generally indicated if lymph node metastases have been proven. Concerning clinically proven medullary thyroid carcinoma, bilateral cervicolateral lymph node dissection is generally indicated, since lymph node metastases may be missed preoperatively but are often found histologically. In patients with parathyroid carcinoma, en bloc ipsilateral cervicocentral lymph node dissection should be performed in addition to parathyroidectomy and hemithyroidectomy. Lymph node dissection should always be performed systematically, since lymph node metastases may be missed both clinically and by imaging techniques.
一般而言，甲状腺癌的初次手术应包括全甲状腺切除术和颈中央区淋巴结清扫术。例外情况是微小乳头状癌病例以及因多发性2A型内分泌肿瘤而进行的预防性手术。超出颈中央区的淋巴结清扫也应以分区为导向。如果已证实有淋巴结转移，通常应进行该手术。对于临床确诊的甲状腺髓样癌，一般应进行双侧颈外侧淋巴结清扫，因为术前可能漏诊淋巴结转移，但在组织学检查时往往会发现。对于甲状旁腺癌患者，除甲状旁腺切除术和甲状腺半切术外，还应同时进行同侧颈中央区淋巴结整块清扫。淋巴结清扫应始终系统地进行，因为临床和影像学检查技术都可能漏诊淋巴结转移。
