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目的:探讨甲状腺微小癌的手术切除范围。方法:回顾性分析2009年1月至2012年8月我院收治及病理证实的48例甲状腺微小癌患者的临床资料。结果:本组乳头状微小癌43例,滤泡状微小癌3例,髓样癌l例,未分化癌1例。46例患者获得随访,随访时间为6个月~4年,平均3.5年。未分化癌患者6个月后死亡,1例双侧乳头状微小癌患者术后3.5年复发,给予残余腺体全切加颈功能性清扫术,其余病例随访期间无复发和死亡。结论:对于单侧乳头状微小癌,我们采用病侧加峡部全切及对侧大部分切除的方式进行治疗。双侧乳头状微小癌采用甲状腺全切方式治疗,均行颈清扫术(Ⅱ~IV区淋巴结)。滤泡状癌行病侧加峡部全切对侧次全切除术治疗,同时行颈部淋巴结功能性清扫术。由于髓样癌、未分化癌有局部浸润,淋巴结转移,可适当扩大手术范围,并加颈部淋巴结清扫。
Objective: To investigate the surgical resection of thyroid microcarcinoma. Methods: The clinical data of 48 patients with thyroid microcarcinoma confirmed by pathology in our hospital from January 2009 to August 2012 were retrospectively analyzed. Results: The group of papillary micro-cancer in 43 cases, follicular micro-cancer in 3 cases, medullary carcinoma in 1 case, undifferentiated carcinoma in 1 case. 46 patients were followed up for 6 months to 4 years, an average of 3.5 years. Undifferentiated cancer patients died after 6 months, 1 case of bilateral papillary micro-cancer recurrence 3.5 years after surgery, giving residual gland resection and cervical functional dissection, the rest of the cases were no recurrence and death during follow-up. Conclusion: For unilateral papillary microcarcinoma, we treated the affected side with isthmic resection and resection of most of the contralateral side. Bilateral papillary microcarcinoma was treated by total thyroidectomy. Both patients underwent neck dissection (lymph nodes in zone II-IV). Follicular carcinoma of the diseased side plus isthmic resection of the contralateral subtotal total resection, while cervical lymph node dissection. Due to medullary carcinoma, undifferentiated carcinoma with local infiltration, lymph node metastasis, may be appropriate to expand the scope of surgery, and neck lymph node dissection.