Block M A
Ann Surg. 1977 Feb;185(2):133-44. doi: 10.1097/00000658-197702000-00001.
Greater precision has developed in recent decades in the selection of patients for operation for thyroid nodules suspicious for malignancy and in adapting operative procedures to the extent and pathologic variety of the individual thyroid carcinoma, when present. A thyroid lobectomy is considered to be the minimal operative procedure usually indicated for a suspicious thyroid nodule or carcinoma involving one lobe of the thyroid gland. Factors determining the extent of operation for thyroid carcinoma include the pathologic variety, gross distribution of the malignancy, and health status of the individual patient. Total or near total thyroidectomy should be considered for all patients with thyroid carcinoma except for single occult carcinomas and unilateral low grade angio-invasive carcinomas. Removal of lymph nodes in regions adjacent to the thyroid carcinoma is advisable, lateral neck dissections being reserved for patients with palpable lymphadenopathy, demonstrated metastases to lateral cervical lymph nodes, or a poorly differentiated carcinoma likely to metastasize to these lymph nodes. A modified radical lymph node dissection is satisfactory except for those carcinomas invading muscles in the neck. Anatomic neck dissections provide a better prognosis than incomplete lymph node procedures for patients with regional lymph node metastases. Following operation, patients should receive thyroid hormone therapy, be evaluated for possible treatment with radioactive iodine or other therapeutic measures, and be followed for evidence of recurrent disease as well as thyroid and parathyroid function. Adequate early operation is preferred to late ultraradical procedures, from standpoints of morbidity and prognosis. Unfavorable prognostic factors include extensive gross disease, poorly differentiated carcinoma present as the entire lesion or as foci in a differentiated carcinoma, and age over 40. With adequate surgical treatment, the prognosis for operable thyroid carcinoma is good.
近几十年来，在为疑似恶性的甲状腺结节选择手术患者以及使手术程序适应个体甲状腺癌（若存在）的范围和病理类型方面，已经有了更高的精准度。甲状腺叶切除术被认为是通常适用于疑似甲状腺结节或累及甲状腺一叶的癌的最小手术程序。决定甲状腺癌手术范围的因素包括病理类型、恶性肿瘤的大体分布以及个体患者的健康状况。除了单发隐匿性癌和单侧低级别血管浸润性癌之外，所有甲状腺癌患者都应考虑行全甲状腺切除术或近全甲状腺切除术。建议切除甲状腺癌邻近区域的淋巴结，对于有可触及的淋巴结病、已证实有侧颈淋巴结转移或可能转移至这些淋巴结的低分化癌患者，应行侧颈淋巴结清扫术。除了那些侵犯颈部肌肉的癌之外，改良根治性淋巴结清扫术就足够了。对于有区域淋巴结转移的患者，解剖性颈淋巴结清扫术比不完全淋巴结手术预后更好。手术后，患者应接受甲状腺激素治疗，评估是否可能采用放射性碘或其他治疗措施，并随访有无疾病复发以及甲状腺和甲状旁腺功能的证据。从发病率和预后的角度来看，早期进行充分的手术优于晚期的超根治性手术。不良预后因素包括广泛的大体病变、以整个病变或分化型癌中的病灶形式出现的低分化癌以及年龄超过40岁。通过充分的手术治疗，可手术的甲状腺癌预后良好。
