Keminger K, Kober F, Hermann M
Chirurgischen Abteilung, Kaiserin-Elisabeth-Spitales der Stadt Wien.
Zentralbl Chir. 1989;114(18):1209-16.
Between 1978-1987 a reoperation had to be performed on 115 patients with carcinoma of the thyroid gland due to oncologically inadequate initial surgery. In papillary carcinomas, the high percentage of T1-tumors (43.1%) were the reason for lack of prae- or intraop. diagnostic evaluation, with the follicular carcinomas the high percentage of borderline frozen section. With invasive carcinomas, residues of the tumor were found either in the remaining thyroid tissue or in the lymph nodes (20.8%) while no further tumor has been found in encapsulated carcinomas. The rate of recurrent nerve paralysis document right after reportation was 18%, and its frequency depended on the time interval between initial surgery and reoperation. With encapsulated carcinomas of the type T1 we would suggest not to consider a reoperation, because we do not expect intrathyreoidal metastasation nor tumor involved lymph nodes and the risk of causing a recurrent nerve paralysis by a reoperation is not justifiable.
1978年至1987年间，115例甲状腺癌患者因初次手术肿瘤学处理不充分而需再次手术。在乳头状癌中，T1期肿瘤比例较高（43.1%）是术前或术中缺乏诊断评估的原因，在滤泡状癌中则是临界冰冻切片比例较高。对于浸润性癌，在剩余甲状腺组织或淋巴结中发现肿瘤残留（20.8%），而在包膜内癌中未发现进一步肿瘤。报告后立即记录的喉返神经麻痹发生率为18%，其发生率取决于初次手术与再次手术之间的时间间隔。对于T1型包膜内癌，我们建议不考虑再次手术，因为我们预计不会发生甲状腺内转移或肿瘤累及淋巴结，且再次手术导致喉返神经麻痹的风险是不合理的。
