摘要
目的 :回顾分析甲状腺乳头状癌治疗效果 ,探讨外科治疗最佳方案。方法 :对我院 1984～ 1996年收治的 2 2 8例甲状腺乳头状癌患者手术治疗结果进行分析。 2 2 8例患者中肿瘤位于单侧叶者 16 2例 ,狭部 18例 ,双叶 34例 ,侵犯甲状软骨及气管 14例。颈淋巴 c N0 14 8例 ,c N+ 80例。术后均随访 5年以上。结果 :c N+者行功能性 (41例 )和根治性颈清扫(39例 )的 5年生存率分别为 87.8% (36 / 4 1)和 87.2 % (34/ 39)。腺内型 c N0 伴被膜侵犯者行选择性颈清扫 2 1例 ,随诊观察 2 0例 ,其 5年生存率分别为 90 .5 % (19/ 2 1)和 90 .0 % (18/ 2 0 ) ;腺内型 c N0 不伴被膜侵犯者均未行颈清扫 ,其 5年生存率为 99.0 % (99/ 10 0 ) ,5年内发生颈淋巴结转移率为 1.0 % (1/ 10 0 ) ;腺外型 c N0 行颈清扫 4例 ,5年内发生对侧转移为1/ 4 ,3例未行颈清扫者 5年内发生颈淋巴转移为 2 / 3。腺叶切除术后对侧复发率为 2 .4 7% (4/ 16 2 )。行全甲状腺切除的5年生存率为 85 .7% (12 / 14 ) ,被膜内全甲状腺切除的 5年生存率为 85 .0 % (17/ 2 0 )。侵犯甲状软骨板及气管者 ,行喉全切除 ,其 5年生存为 3/ 5 ,保留喉功能的 5年生存为 6 / 9。结论 :对甲状腺乳头状癌提倡功能性颈清扫 ;腺内型 c N0 者主张随访观察 。
Objective: Present the results of retrospective study of the management on thyroid papillary carcinoma for exploring the optimal tactics.Methods:Two hundred twenty eight patients were treated by surgery of several different tactics in our department from 1984 to 1996 and followed up over 5 years after treatment.There were 60 males and 168 females,ranging in age from 7 to 76 years old.The clinical data of 228 cases with papillary carcinoma were summarized in this paper.The clinical stage of cervical lymph node was cN 0 in 148,cN + in 80.Results:The 5\|year survival rate was 87 8%(36/41) and 87 2%(34/39) on the modified neck dissection and the radical neck dissection respectively in 80 cN + patients.Among 148 cN 0,121 were type of not out of the thyroid,7 were type of out of the thyroid.The 5\|year survival rates were 90 5%(19/21) and 90 0%(18/20) on the group of modified neck dissection and the group of follow\|up respectively (41 cases of cN 0 with tumor corroding the thyroid membrane).The 5\|year survival rate was 99 0%(99/100) in 100 cN 0 within the membrane which were no neck dissection for the type of not out of thyroid.The 5\|year survival rate was 85 7%(12/14) and 85 0%(17/20) for total thyroidectomy and total thyroidectomy within the membrane respectively.For the cases with tumor corroding out of the thyroid,the 5\|year survival rate was 3/5 and 6/9 for total laryngectomy and partial laryngectomy respectively.The opposite recurrence rate was 2 47%(4/162) for leaf thyroidectomy.Conclusion:Give leaf and strait thyroidectomy to the patients whose primary tumor were within one leaf,strait and bilateral 1/3 leaf to patients with tumor in the strait,total thyroidectomy within the membrane to the patients with 2 sites tumor.The functional neck dissection and partial laryngectomy should be recommendation for patients with thyroid papillary carcinoma.For cN 0 cases and primary tumor not out of the thyroid,the follow\|up should be recommendation.Neck dissection should be given to all patients with tumor corroding out of the thyroid.
出处
《耳鼻咽喉（头颈外科）》
2002年第6期349-351,共3页
Chinese Arch Otolaryngology-Head Neck Surg
