Dralle H, Lorenz K, Machens A
Universitätsklinik für Allgemein-, Viszeral- und Gefässchirurgie, Universitätsklinikum Halle (Saale), Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, 06097 Halle.
Chirurg. 2009 Nov;80(11):1069-82; quiz 1083. doi: 10.1007/s00104-009-1769-x.
The 5 main types of thyroid cancer (papillary, PTC, follicular, FTC, poorly differentiated, PDTC undifferentiated, UTC, medullary, MTC) not only differ regarding morphology, pathogenesis, genetics,and pathophysiology (iodine metabolism, thyroglobulin and calcitonin production), but also concerning tumor biology, metastatic behavior (lymphogenous, locally invasive and hematogenous routes) and prognosis. Knowledge of these features is the basis of the surgical concept of one or two-stage thyroidectomy, the exceptions and the concept of locoregional lymph node dissection. Lymph node surgery plays an important role in those cancers exhibiting mainly lymph node metastases (PTC, MTC) not only due to frequent recurrences but also due to its potential curative intent. Differentiated carcinomas may have an acceptable prognosis despite local invasion of the cervical aerodigestive system, thus resections are justified when technical prerequisites are given.
甲状腺癌的5种主要类型(乳头状癌,PTC;滤泡状癌,FTC;低分化癌,PDTC;未分化癌,UTC;髓样癌,MTC)不仅在形态学、发病机制、遗传学和病理生理学(碘代谢、甲状腺球蛋白和降钙素生成)方面存在差异,而且在肿瘤生物学、转移行为(淋巴道、局部浸润和血行途径)及预后方面也有所不同。了解这些特征是一期或二期甲状腺切除术手术理念、例外情况以及区域淋巴结清扫概念的基础。淋巴结手术在那些主要表现为淋巴结转移的癌症(PTC、MTC)中起着重要作用,这不仅是因为频繁复发,还因为其潜在的治愈意图。尽管分化型癌侵犯了颈部气消化道系统,但预后仍可能尚可,因此在具备技术条件时进行切除术是合理的。