Baker R R, Hyland J
Surg Gynecol Obstet. 1985 Dec;161(6):546-50.
The results of this analysis have demonstrated that papillary carcinoma of the thyroid gland rarely causes the death of the patient. Bilateral subtotal lobectomies, partial lobectomies and probably total lobectomy combined with contralateral partial lobectomy should not be performed in the treatment of this disease. The incidence of local recurrence is higher after these procedures, and any subsequent operative procedure is complicated by scarring secondary to the initial procedure. Total lobectomy is the procedure of choice for patients with disease confined to one lobe on palpation. Total thyroidectomy should only be performed for palpable disease in both lobes. Excision of a grossly normal contralateral lobe solely to obtain microscopic tumor which rarely becomes clinically apparent is not worth the inherent risk of bilateral recurrent palsy of the nerve or permanent hypoparathyroidism. Cervical metastasis of the lymph nodes which are detected either synchronously or during subsequent follow-up examination can almost always be resected by some type of modified neck dissection. A radical neck dissection with the resection of the jugular vein and the sternocleidomastoid muscle is rarely if ever necessary. The administration of thyroid hormone as a surgical adjuvant may not be of any benefit and its routine use is probably not necessary.
该分析结果表明，甲状腺乳头状癌很少导致患者死亡。在这种疾病的治疗中，不应进行双侧次全叶切除术、部分叶切除术，可能也不应进行全叶切除术加对侧部分叶切除术。这些手术之后局部复发的发生率较高，且任何后续手术都会因初次手术继发的瘢痕而变得复杂。对于触诊发现病变局限于一叶的患者，全叶切除术是首选手术方式。仅当双侧叶均有可触及的病变时才应进行甲状腺全切除术。仅为获取很少会出现临床症状的微小肿瘤而切除大体正常的对侧叶，不值得冒双侧喉返神经麻痹或永久性甲状旁腺功能减退的固有风险。在同步检查或后续随访检查中发现的颈部淋巴结转移，几乎总能通过某种改良颈部清扫术切除。很少（如果有的话）需要进行切除颈静脉和胸锁乳突肌的根治性颈部清扫术。将甲状腺激素用作手术辅助治疗可能没有任何益处，常规使用可能也没有必要。
