Clark O H
Ann Surg. 1982 Sep;196(3):361-70. doi: 10.1097/00000658-198209000-00016.
There is considerable controversy about the most appropriate treatment of patients with thyroid cancer. This report concerns the author's experience with 82 consecutive patients having total thyroidectomy from January 1977 through December 1981. The age of the patients ranged from 21 to 86 years (mean age 44 years). There were 44 women and 38 men. Twenty-four patients (29%) had had previous thyroid operations; ten patients (11%) had coexistent parathyroid adenomas removed; and seven patients (8.5%) had modified radical neck dissections. Thirty-four patients (41%) had a history of radiation to the head and neck, and 12 (35%) of the 34 irradiated patients and 51 (63%) of the entire group of 82 patients had thyroid cancer (45 papillary, five follicular, one medullary). Coexistent lesions in the patients with papillary cancer included Hashimoto's thyroiditis, five patients; parathyroid adenomas, four patients; Graves' disease, one patient; Hurthle cell neoplasm, one patient; and amyloid struma, one patient. If less than total thyroidectomy had been performed, 26 (51%) of the 51 patients with thyroid cancer would have had cancer left in the residual thyroid lobe, and focal cancers in the lobe opposite to the one containing the nodule for which the operation was performed would have been missed in five patients (10%). Five of the 20 patients with unilateral cancer had follicular cancer. Complications included one case of permanent hypoparathyroidism and two cases of transient bilateral recurrent laryngeal nerve palsy. Ninety-six per cent of the patients were discharged within four days of thyroidectomy, 94% by three days, and 79% by two days. Uptake of radioactive iodine was not above background levels in nine (26%) of the 35 patients studied after operation and was less than 1% in the remainder. These data suggest that total thyroidectomy is the treatment of choice for patients with thyroid cancer because residual cancer would persist in the remaining thyroid tissue in at least 61% of patients if only lobectomy had been performed. Total thyroidectomy can be done with minimal permanent disability in patients with benign and malignant thyroid tumors, in patients who have had previous thyroid operations, and in patients with coexistent hyperparathyroidism.
对于甲状腺癌患者最合适的治疗方法存在相当大的争议。本报告涉及作者在1977年1月至1981年12月期间连续为82例患者进行甲状腺全切除术的经验。患者年龄从21岁到86岁不等（平均年龄44岁）。其中女性44例，男性38例。24例患者（29%）曾接受过甲状腺手术；10例患者（11%）同时切除了甲状旁腺腺瘤；7例患者（8.5%）接受了改良根治性颈清扫术。34例患者（41%）有头颈部放疗史，34例接受放疗的患者中有12例（35%）以及82例患者中的51例（63%）患有甲状腺癌（45例乳头状癌、5例滤泡状癌、1例髓样癌）。乳头状癌患者的并存病变包括桥本甲状腺炎5例；甲状旁腺腺瘤4例；格雷夫斯病1例；许特耳细胞肿瘤1例；淀粉样甲状腺肿1例。如果未进行甲状腺全切除术，51例甲状腺癌患者中有26例（51%）的残余甲状腺叶会残留癌症，并且在5例患者（10%）中会漏诊手术所针对结节所在叶对侧叶中的局灶性癌症。20例单侧癌患者中有5例为滤泡状癌。并发症包括1例永久性甲状旁腺功能减退和2例暂时性双侧喉返神经麻痹。96%的患者在甲状腺切除术后4天内出院，94%在3天内出院，79%在2天内出院。35例术后接受研究的患者中有9例（26%）放射性碘摄取未高于背景水平，其余患者低于1%。这些数据表明，甲状腺全切除术是甲状腺癌患者的首选治疗方法，因为如果仅进行叶切除术，至少61%的患者剩余甲状腺组织中会残留癌症。对于良性和恶性甲状腺肿瘤患者、曾接受过甲状腺手术的患者以及并存甲状旁腺功能亢进的患者，甲状腺全切除术可以在造成最小永久性残疾的情况下完成。
