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目的探讨甲状腺乳头状癌的诊断及并发症的处理。方法回顾性分析1995-2004年南昌大学第二附属医院经手术和病理证实的136例甲状腺乳头状癌的临床资料。结果术中冰冻切片诊断符合率为98.2%(111/113),显著高于术前B超、CT和细针穿刺细胞学检查,上述三者的正确诊断率分别为25.8%(16/62)、80.0%(24/30)和78.1%(25/32)。术后低钙血症、喉返神经麻痹及乳糜漏的发生率分别为8.8%(12/136)、2.2%(3/136)和1.5%(2/136)。结论术中冰冻快速切片是诊断甲状腺乳头状癌的可靠依据;胸导管漏口-大隐静脉-颈内静脉搭桥吻合术是治疗高流量乳糜漏的好方法。
Objective To investigate the diagnosis and complications of thyroid papillary carcinoma. Methods The clinical data of 136 cases of papillary thyroid carcinoma confirmed by operation and pathology from the Second Affiliated Hospital of Nanchang University from 1995 to 2004 were retrospectively analyzed. Results The coincidence rate of intraoperative frozen section diagnosis was 98.2% (111/113), which was significantly higher than that of preoperative ultrasonography, CT and fine needle aspiration cytology. The correct diagnostic rates of these three were 25.8% (16/62) , 80.0% (24/30) and 78.1% (25/32) respectively. Postoperative hypocalcemia, recurrent laryngeal nerve paralysis and chylothorax rates were 8.8% (12/136), 2.2% (3/136) and 1.5% (2/136), respectively. Conclusion Intraoperative rapid frozen section is a reliable basis for the diagnosis of papillary thyroid carcinoma. Thoracic catheter leakage, great saphenous vein and internal jugular vein bypass anastomosis is a good way to treat high-flow chylous leakage.