【摘要】 目的:研究甲状腺癌行肿瘤切除或腺叶次全切除术后腺体残癌率和颈部淋巴结转移的情况,明确甲状腺癌的切除范围与手术方式。方法:对1996年～2005年间在外院行腺叶肿交瘤切除或次全切除术后来我院行二次手术治疗的57例甲状腺癌患者进行分析研究。结果:总的癌残留率为49.1%(28/57)。原发部位残癌率为29.8%(17,57),术后病理淋巴结转移癌21例,淋巴结转移率为52.5%(21/40),患侧颈部Ⅵ区淋巴结转移率为35.0%(14/40)。我院二次手术所致喉返神经麻痹的发生率为1.8%(1/57)。甲状腺癌颈淋巴结转移与被膜侵犯正相关。结论:甲状腺癌行肿块切除或腺叶次全切除术的术后残癌率较高。有被膜侵犯的甲状腺乳头状癌患者,应行改良性颈清扫术。术中疑为甲状腺癌时,应常规行颈部Ⅵ区探查,必要时应行该区清扫术。术中避免喉返神经和甲状旁腺的损伤。更多还原

【Abstract】 Objective: To evaluate the rate of residual disease in the thyroid gland and that of cervical lymph node metastasis after preliminary local resection of thyroid cancer. Methods: From 1996 to 2005, a total of 57 thyroid cancer patients previously treated with noduiectomy or subtotal lobectomy received reoperation. Results: The rate of residual disease at the primary site was 29.8 (17/57). The rate of lymphnode metastasis was 52.5% (21/40). The lymph node metastasis rate at level VI was 35.0 (14/40). The rate of laryngeal recurrent nerve injury was 1.8% (1/57) at the second operation. The cervical lymph node mteastasis was positively correlated with the capsule aggression. Conclusion: Because of high rate of local residual disease, noduiectomy or subtotal lobectomy alone is not indicated for thyroid cancer. Modified cervival lymphadenectomy is necessary for papillary thyroid carcinoma with capsule aggression. The exploration to level VI is needed for thyroid cancer. Parathyroid injury and laryngeal recurrent nerve injury should be avoided during surgery for thyroid carcinoma.更多还原