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目的 :探讨分化型甲状腺癌外科治疗术式的选择。方法 :对 6 6例分化型甲状腺癌病例行患侧腺叶、峡部加对侧次全切除术 49例 ,患侧腺叶及峡部切除术 7例 ,一侧腺叶次全切除及对侧部分切除术 6例 ,全甲状腺切除术 4例。行患侧功能性颈清扫术加对侧功能性颈清扫术 43例 ,双侧功能性颈清扫术 1例及患侧传统性颈清扫术 10例 ,患侧传统性颈清扫术 5例。结果 :3年生存率 96 % (2 5 /2 6 ) ,5年生存率 94% (17/18) ,1例死于白血病 ,1例失访。 4例行全甲状腺切除术的病例术后均出现甲状腺功能减退 ,其中 2例出现甲状旁腺功能减退(5 0 % ) ,其他病例均未发生甲状腺功能和甲状旁腺功能减退。无一例发生喉返神经麻痹。结论 :对分化型甲状腺癌 ,主张行患侧腺叶切除加对侧次全切除或大部切除 ;如术前发现颈淋巴结肿大 ,应同时行患侧淋巴结清扫术。而N0 患者 ,除了对高危组 (男 >41岁 ,女 >5 1岁 )患者腺体外乳头状瘤或明显侵犯包膜的滤泡型腺癌者应行功能性颈清扫术 ,其他随访容易的N0 患者可以不必常规行颈清扫术 ,并提倡长期密切随访。
Objective: To explore the choice of surgical treatment for differentiated thyroid cancer. METHODS: Forty-six patients with differentiated thyroid cancer were treated with ipsilateral glands and isthmus plus contralateral subtotal resection. The ipsilateral gland and isthmectomy were performed in 7 patients. Subtotal glandectomy and contralateral resection were performed. Resection was performed in 6 cases and total thyroidectomy in 4 cases. Functional ipsilateral neck dissection plus contralateral functional neck dissection in 43 cases, bilateral functional neck dissection in 1 case and conventional ipsilateral neck dissection in 10 cases, ipsilateral conventional neck dissection in 5 cases. Results: The 3-year survival rate was 96% (25/26), the 5-year survival rate was 94% (17/18), 1 case died of leukemia, and 1 case was lost. Hypothyroidism occurred in 4 patients undergoing total thyroidectomy, and hypoparathyroidism (50%) occurred in 2 patients. No thyroid function or hypoparathyroidism occurred in other cases. No case of recurrent laryngeal nerve paralysis occurred. Conclusion: For differentiated thyroid carcinoma, it is advisable to perform bilateral lobectomy with contralateral subtotal resection or subtotal resection. If lymphadenopathy is found before operation, ipsilateral lymph node dissection should be performed at the same time. In N0 patients, functional neck dissection should be performed in patients with high-risk group (male>41 years old, female>51 years old), with glandular extra-papillary neoplasia or follicular adenocarcinoma with obvious invasive capsules. Other follow-ups are easy. Patients with N0 do not need routine neck dissection and long-term close follow-ups are encouraged.