Sim R, Soo K C
Department of General Surgery, Singapore General Hospital, Singapore.
J R Coll Surg Edinb. 1998 Aug;43(4):239-43.
Patients with differentiated thyroid cancers generally have a good prognosis. This should be considered when deciding the extent of surgical resection. Radical surgery, however, may be appropriate in the control of locally advanced disease. An audit of 149 cases of thyroid cancer treated in the Department of General Surgery, Singapore General Hospital between October 1988 and June 1994 is presented. Particular attention is drawn to eight patients who underwent radical surgery. There were 111 (74.5%) women and 38 (25.5%) men. The median age was 45 years (range 12 to 83 years) and 80.5% of the cancers were papillary carcinomas, 14.8% follicular, 2.7% medullary and 2.0% anaplastic. Total or near-total thyroidectomy was the most common procedure for primary disease in about 75% of patients. Eight patients (5.4%) underwent radical surgery-four laryngectomy, one pharyngectomy and three median sternotomy-for tumour clearance. Morbidity included: wound complications in 2%; hypocalcaemia, transient in 16.8% and permanent in 3.4%; and hoarseness of voice in 8.1% with 4.7% having proved recurrent laryngeal nerve palsy. All three patients with anaplastic thyroid cancer died within 3 months. Of the eight who underwent radical surgery, three (37.5%) are alive and disease-free at median follow-up of 20 months. In a correctly selected group of patients with locally invasive differentiated thyroid cancer, aggressive surgery is appropriate, with acceptable morbidity and mortality.
分化型甲状腺癌患者的预后通常较好。在决定手术切除范围时应考虑到这一点。然而，根治性手术可能适用于控制局部晚期疾病。本文介绍了对1988年10月至1994年6月期间在新加坡总医院普通外科治疗的149例甲状腺癌病例的审计情况。特别关注了8例接受根治性手术的患者。其中女性111例（74.5%），男性38例（25.5%）。中位年龄为45岁（范围12至83岁），80.5%的癌症为乳头状癌，14.8%为滤泡状癌，2.7%为髓样癌，2.0%为未分化癌。约75%的患者以全甲状腺切除或近全甲状腺切除作为原发性疾病的最常见手术方式。8例患者（5.4%）接受了根治性手术——4例喉切除术，1例咽切除术和3例正中胸骨切开术——以清除肿瘤。并发症包括：伤口并发症2%；低钙血症，暂时性的占16.8%，永久性的占3.4%；声音嘶哑占8.1%，其中4.7%经证实为喉返神经麻痹。3例未分化甲状腺癌患者均在3个月内死亡。在接受根治性手术的8例患者中，3例（37.5%）在中位随访20个月时存活且无疾病。在正确选择的局部侵袭性分化型甲状腺癌患者组中，积极的手术是合适的，其发病率和死亡率可接受。
