Huang Hui, Xu Zhen-Gang, Liu Shao-Yan, Wang Xiao-Lei
Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Department of Head and Neck Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. Email:
Zhonghua Zhong Liu Za Zhi. 2013 Nov;35(11):871-4.
Well differentiated thyroid carcinoma (WDTC) may be located in the isthmus. The guidelines now have not mentioned an appropriate procedure for WDTC in the isthmus. The aim of this study was to retrospectively analyze the outcomes in patients with WDTC in the isthmus treated at our institution.
Twenty-seven patients with WDTC in the isthmus were managed by surgery in the Cancer Hospital of Chinese Academy of Medical Sciences from 1985-2006. Their demographic data, surgical procedures, pathological features, stages and outcomes were analyzed.
Five patients were men and 22 were women. The median age was 41 (range, 20-69) years. Nine patients received isthmusectomy, fourteen patients received extended isthmusectomy and four received isthmusectomy with unilateral lobectomy. There were no complications of recurrent laryngeal nerve palsy or hypocalcaemia. The median size of lesion was 1.0 cm(range, 0.5-4.0 cm). Sixteen patients had a pathologically T1a lesion (pT1a), seven patients were pT1b, two patients were pT2 and two pT3. Three patients had papillary carcinoma detected in perithyroid lymph nodes (pN1a). Among the 27 cases, 25 patients had a solitary malignant nodule confined to the isthmus, one had two malignant nodules confined to the isthmus and one had two malignant nodules located separately in the isthmus and right lobe. The patients were followed up with a median follow-up time of 85 months(range, 37-274 months). The 5-year recurrence-free survival was 95.2% and overall survival rate was 100%.
Our results suggest that isthmusectomy or extended isthmusectomy are feasible and efficient for the patients with WDTC located in the isthmus, and concurrent pretracheal lymph node dissection should be considered.
高分化甲状腺癌（WDTC）可能位于甲状腺峡部。目前的指南尚未提及针对峡部WDTC的合适手术方式。本研究的目的是回顾性分析在我院接受治疗的峡部WDTC患者的治疗结果。
1985年至2006年期间，中国医学科学院肿瘤医院对27例峡部WDTC患者进行了手术治疗。分析了他们的人口统计学数据、手术方式、病理特征、分期和治疗结果。
5例为男性，22例为女性。中位年龄为41岁（范围20 - 69岁）。9例患者接受了峡部切除术，14例接受了扩大峡部切除术，4例接受了峡部切除加单侧甲状腺叶切除术。未出现喉返神经麻痹或低钙血症等并发症。病变的中位大小为1.0 cm（范围0.5 - 4.0 cm）。16例患者病理分期为T1a期（pT1a），7例为pT1b期，2例为pT2期，2例为pT3期。3例患者在甲状腺旁淋巴结中检测到乳头状癌（pNla）。2例患者有一个局限于峡部的孤立性恶性结节，1例有两个局限于峡部的恶性结节，1例有两个分别位于峡部和右叶的恶性结节。对患者进行随访，中位随访时间为85个月（范围37 - 274个月）。五年无复发生存率为95.2%，总生存率为100%。
我们的结果表明，峡部切除术或扩大峡部切除术对于位于峡部的WDTC患者是可行且有效的，并且应考虑同时进行气管前淋巴结清扫。
