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目的:探讨甲状腺肿瘤的治疗效果。方法:回顾性分析1995年2004年十年间1862例甲状腺肿瘤(1524例甲状腺良性肿瘤,338例的甲状腺癌)的临床资料及随访结果。结果:外科手术操作技术一律采用包膜解剖技术(除峡部外),即常规显露喉返神经及逐一结扎进人甲状腺的三级血管分支,既避免损伤喉返神经,又保留了甲状旁腺血供。局限于一侧的良性肿瘤以甲状腺腺叶切除,双侧甲状腺良性肿瘤,以较大一侧的甲状腺腺叶切除加对侧肿块切除术;T1-T3期分化性甲状腺癌,行一侧的甲状腺腺叶+峡部切除,对T4期分化性甲状腺癌,则进行全甲状腺切除或近全甲状腺切除术;对甲状腺髓样癌行全甲切除+功能性颈清术;临床NO分化型甲状腺癌行甲状腺腺叶+峡部切除+中央区淋巴结清扫术。手术并发症包括术后出血2例(0.1%),乳糜漏1例(0.05%)2例暂时性甲状旁腺功能低下,无喉返神经损伤及永久性甲状腺功能低下。结论:严格掌握甲状腺肿瘤外科的治疗原则及熟悉包膜解剖技术是甲状腺外科手术的关键。
Objective: To investigate the therapeutic effect of thyroid tumors. Methods: The clinical data and follow - up results of 1862 thyroid tumors (1524 thyroid benign tumors and 338 thyroid carcinomas) from 1995 to 1995 were retrospectively analyzed. Results: Surgical operation technique used all kinds of capsule anatomical technique (except isthmus), which showed the recurrent laryngeal nerve and the tertiary vessel branches which were ligated into the thyroid gland one by one, which not only prevented the recurrent laryngeal nerve but also retained the parathyroid blood for. Side of the benign tumor with thyroid gland lobectomy, benign bilateral thyroid tumors, to the larger side of the thyroid gland lobectomy plus contralateral tumor resection; T1-T3 stage differentiated thyroid cancer, line side of the thyroid Gland leaf + isthmus resection, for T4 differentiated thyroid cancer, then underwent total thyroidectomy or near total thyroidectomy; thyroid medullary carcinoma line full of thyroidectomy + functional neck dissection; clinical differentiation of thyroid cancer thyroid Gland leaf + isthmic resection + central lymph node dissection. Surgical complications included 2 cases of postoperative bleeding (0.1%), 1 case of chylothia (0.05%), 2 cases of transient hypoparathyroidism, no recurrent laryngeal nerve injury and permanent hypothyroidism. Conclusion: Strict control of the thyroid tumor surgical principles and familiar with the anatomical technique is the key thyroid surgery.