摘要
目的：分析分化型甲状腺癌术后癌肿复发或残留与初次手术的关系，探讨初次手术如何规范化问题。方 法：总结分化型甲状腺癌41例再手术病人的资料，分析癌复发或残留与初次手术方式的关系、与疾病分期的关系 等，并结合美、日等国的手术指南对初次手术的规范化进行探讨。结果：① 平均年龄48岁，男：女=1∶1． 9，其中乳头状 癌31例，滤泡癌5例，髓样癌4例和 Hurthle 细胞癌1例。② 2次手术时间间隔：第2次手术距第1次时间平均58． 2 个月；第3次手术距第2次为48． 4个月；第4次距第3次为23． 4月；第5次距第4次为24． 5个月；第6次距第5次 和第7次距第6次的时间均为12个月。③ 初次手术方式与腺体残癌率：患侧部分切除术的腺体残癌率为100%(6/ 6) ，双侧大部的残癌率也为100%(4/4) ，而“患侧全切”和“患侧全切加对侧大部”的残癌率相似，分别是37． 5%(3/8) 和 40%(2/5) 。④ 分期与再手术：32例可进行 UICC 分期：Ⅰ期17例、Ⅱ期3例、Ⅲ期7例和Ⅳ期5例。早期组(Ⅰ+Ⅱ 期)和晚期组(Ⅲ+Ⅳ期)第1和第2次手术的间隔时间分别是52． 2和37． 9个月(P=0． 424) 。⑤ 淋巴结转移率：第1次 手术中，仅6例行淋巴结切除术，阳性率为100%(6/6) 。第2次术中，有24例行了淋巴结切除术，阳性率70． 8%(17/ 241。⑥ 初次手术规范率：如以“患侧全切”为最小可接受术式的话，初次手术不规范率为48． 7%(20/41) 。如以“患侧全 切加对侧大部”为标准术式的话，不规范率竟高达70． 7%(29/41) 。结论：目前甲状腺癌的初次手术还存在着明显的不 规范；腺体切除不够和淋巴结清扫术实施率过低是影响效果的主要原因；加强对本病危险因素的了解和规范初次手 术是改善预后的关键。
Objective To investigate the detailed conditions of the first operation in well-differentiated thyroid cancer （WDTC） and the relationship between post-operative recurrence and the detailed conditions of their first operations. Methods The clinical data of 41 patients with recurrent WDTC were collected, and the relationship between recurrence and the detailed conditions of their first operation was analyzed. Results ① The average age of the patients was 48 years. There were 31 papillary, 5 follicular, 4 medullary and 1 Hurthle＇s thyroid cancer; ② The intervals between the second and the first operations were 58.2 m, between the third and the second were 48.4 m, between the fourth to the third were 23.4 m, between the fifth and the fourth were 24.5 m, between the sixth and the fifth, and between the seventh and the sixth were 12 m; ③ The rate of recurrence in the residual thyroid was 100% in patients with unilateral partial lobectomy （6/6）and bilateral sublobectomy （4/4）; ④ There were 6 among 24 patients who underwent lymphadenectomy during the first and the second operations, and their positive rates were 100%（6/6）and 70.8% （17/24） respectively. ⑤ If “unilateral total lobectomy”or “total lobectomy＋contralateral sublobectomy” were taken as the standard procedures, rate of standard procedures were 48.7% （20/41） and 70.7% （29/41） respectively. Conclusions The first operation was often nonstandard; during the first operation, not undergoing total lobectomy or performing in sufficient lymphadenectomy are the main causes of early recurrence.
出处
《外科理论与实践》
2005年第6期509-512,共4页
Journal of Surgery Concepts & Practice
关键词
分化型甲状腺肿瘤
再手术
复发
规范化
Well-differentiated thyroid cancer
Operation
Recurrence
Standardization
