摘要
目的:探讨分化型甲状腺癌不规范手术后再次手术方法及预后分析。方法:回顾性分析我院2006年10月~2012年12月间收治的80例在外院行甲状腺次全或部分切除的甲状腺癌患者为再次手术组,均在我院接受再次手术。再次手术方式包括甲状腺残叶切除、对侧甲状腺切除、中央区淋巴结清扫、颈侧淋巴结清扫等。同时随机选取同时间在我院接受规范手术的160例分化型甲状腺癌初诊患者作为对照组,比较两组的并发症发生情况、生存及预后结果。结果:再次手术组病例术后病理检查发现,残余甲状腺腺体有癌细胞18例(22.5%),淋巴结内有癌细胞56例(70%)。院外首次手术后发生单侧喉返神经损伤5例,双侧损伤1例(总发生率为7.5%)。再次手术后新发的喉返神经损伤2例(2.5%),甲状旁腺功能减退6例(7.5%),喉上神经损伤1例(1.25%),无食管损伤及术后出血。对照组采用标准手术方式,术后出现甲状旁腺功能减退9例(5%)[其中永久性甲状旁腺功能减退3例(1.67%)],喉返神经损伤2例(1.11%),喉上神经损伤1例(0.55%),食管损伤1例(0.55%),术后出血3例(1.67%)。术后随访5年以上,再次手术组出现复发2例(2.5%),对照组复发3例(1.67%),死亡1例(0.55%)。两组喉返神经损伤事件的发生率差异有统计学意义(χ^2=10.226,P<0.05),其余并发症及预后的差异则无统计学意义(P>0.05)。结论:甲状腺癌不规范手术后需再次手术,手术时应充分辨认重要结构以减少手术并发症的发生,及时补救手术不影响患者预后。
Objective:This study aimed to investigate the surgical methods and prognosis of patients who underwent reoperation after local resection of differentiated thyroid carcinoma.Methods:A total of 80 thyroid carcinoma patients undergoing reoperation,including residual lobectomy and contralateral lobectomy,central compartment lymph node dissection,functional neck dissection etc.,in Jiangsu Cancer Hospital from December 2012 to October 2006 after near total thyroidectomy or local resection of differentiated thyroid carcinoma in other hospital were assigned to the reoperation group and analyzed retrospectively.Another 160 differentiated thyroid cancer patients who underwent total thyroidectomy at the same time were randomly selected as control group.Complications,survival and prognosis in the two groups were compared.Results:In the reoperation group,residual cancer cells were observed in the thyroid gland in 18(22.5%)cases and in lymph nodes in 56(70%)cases,and there were 5 cases of unilateral recurrent nerve injury and 1 case of bilateral injury(overall incidence rate=7.5%)after first operation in other hospital.There were 2 cases of new recurrent nerve injury(2.5%),6 cases of hypoparathyroidism(7.5%),1 case of superior laryngeal nerve injury,0 case of esophageal injury and 0 case of postoperative hemorrhage after second surgery.In the control group,standard surgical method was adopted,and there were 9 cases of postoperative parathyroid dysfunction(including 3 cases of permanent parathyroid dysfunction),2 cases of recurrent laryngeal nerve injury,1 case of superior laryngeal nerve injury,1 case of esophageal injury and 3 cases of postoperative hemorrhage.In the over 5-year follow up,two cases of recurrence was found in the reoperation group,and 3 cases of recurrence and 1 death were found in the control group.There were significant difference in the incidence of recurrent laryngeal nerve injury between two groups,and no significant differences in other complications and prognosis.Conclusion:Reoperation is needed after nonstandard thyroid cancer operation.Important tissue should be fully identified in the operation to reduce the incidence of complications.Timely remedial operation does not affect the prognosis of the patient.
作者
吴文澜
王玥
赵炎斌
蒋媛
张园
Wu Wenlan;Wang Yue;Zhao Yanbin;Jiang Yuan;Zhang Yuan(Department of Head and Neck Surgery,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research&The Affiliated Cancer Hospital of Nanjing Medical University&Jiangsu Red Cross Cancer Center,Nanjing 210009,Jiangsu,China)
出处
《肿瘤预防与治疗》
2019年第12期1106-1112,共7页
Journal of Cancer Control And Treatment
基金
江苏省科技厅临床重大专项基金(编号:BE2016796)~~
关键词
甲状腺癌
再手术
喉返神经损伤
Thyroid carcinoma
Reoperation
Recurrent laryngeal nerve injury
