Brooks J R, Starnes H F, Brooks D C, Pelkey J N
Department of Surgery, Brigham and Women's Hospital, Boston, Mass. 02115.
Surgery. 1988 Dec;104(6):940-6.
A total of 1249 "cold" solitary thyroid nodules were excised at the Brigham and Women's Hospital from 1948 through 1987. Of these nodules, 241 showed malignant conditions: 123 were papillary, 42 were mixed papillary-follicular, and 43 were pure follicular carcinomas. There were also 23 anaplastic, 8 medullary, and 3 Hürthle cell carcinomas. These patients were followed up from 3 to 31 years, with a mean range of 10 years. Fifty-three patients with well-differentiated tumors underwent total thyroidectomies, and 179 underwent subtotal thyroidectomies (excluding anaplastic, medullary, and Hürthle cell tumors). Regional lymph node involvement was commonly found but appeared not to affect survival; tumor size and local spread and extent of thyroid gland involvement did affect survival. A small percentage of well-differentiated thyroid tumors do, in time, undergo anaplastic change that leads to metastasis and death. There was no 30-day mortality rate. The late mortality rate was 2% for papillary and 14% for follicular carcinomas. Papillary tumors are becoming more common. Older aged patients and male patients appear to carry poorer prognoses for survival. The total thyroidectomy procedure has not improved survival over subtotal thyroidectomy and carries a higher complication rate.
1948年至1987年期间，布莱根妇女医院共切除了1249个“冷”性甲状腺孤立结节。在这些结节中，241个显示为恶性病变：123个为乳头状癌，42个为乳头状-滤泡状混合癌，43个为纯滤泡状癌。此外，还有23个未分化癌、8个髓样癌和3个嗜酸性细胞癌。这些患者的随访时间为3至31年，平均为10年。53例高分化肿瘤患者接受了甲状腺全切除术，179例接受了甲状腺次全切除术（不包括未分化癌、髓样癌和嗜酸性细胞肿瘤）。区域淋巴结受累常见，但似乎不影响生存率；肿瘤大小、局部扩散及甲状腺受累范围确实影响生存率。一小部分高分化甲状腺肿瘤最终会发生未分化改变，导致转移和死亡。30天死亡率为零。乳头状癌的晚期死亡率为2%，滤泡状癌为14%。乳头状肿瘤越来越常见。老年患者和男性患者的生存预后似乎较差。甲状腺全切除术相比甲状腺次全切除术并未提高生存率，且并发症发生率更高。
