355例甲状腺乳头状癌患者再次手术原因分析

Analysis on the causes of reoperation in 355 patients with thyroid papillary carcinoma

摘要:

目的分析甲状腺乳头状癌术后再次手术的原因，探讨初次手术规范化操作的意义。方法收集中国医学科院肿瘤医院头颈外科及北京大学深圳医院甲乳外科收治的355例甲状腺乳头状癌再次手术患者的临床资料，统计初次手术中甲状腺区及侧颈区术式，对比再次手术情况，分析导致再次手术原因。结果355例患者甲状腺或中央区再次手术者273例，其中初次手术甲状腺切除规范组140例，再次手术距离初次手术平均时间（60.6±54.9）个月；不规范组133例，再次手术距离初次手术平均时间（54.1±41.2）个月，两组再次手术时间有统计学差异(t=0.340，P=0.022);侧颈区再次手术者共99例，其中清扫规范组56例，再次手术距离初次手术平均时间（39.3±33.8）个月；颈部清扫不规范组43例，再次手术距离初次手术平均时间（26±24.1）个月, 两组再次手术时间有统计学差异(t=0.178，P=0.041)。结论 甲状腺乳头状癌患者再次手术的主要原因是甲状腺切除范围不够或侧颈区清扫范围不足。初次手术，单侧单发病灶应至少行患侧及峡部切除加患侧中央区淋巴结清扫术，其余均应行双侧甲状腺全切加患侧中央区淋巴结清扫术。有颈部转移的患者，初次手术应至少行II（IIa）、III、IV区侧颈部清扫。

关键词:甲状腺乳头状癌|再次手术|初次手术

Abstract:

ObjectiveTo analyze the causes of reoperation for papillary thyroid carcinoma and explore the significance of standardization on the initial operation.MethodsClinical data of 355 patients with reoperation of thyroid papillary carcinoma in our departments were collected. The initial surgical methods for the thyroid gland and lateral cervical area were analyzed and compared with those of their operations.ResultsOf all the 355 patients, 17 received reoperation of both thyroid gland and lateral cervical area. 273 patients had reoperation of thyroid gland. Among them, 140 had received standardized initial thyroidectomy (standard group) with an average duration from initial operation to reoperation of（60.6±54.9）months. The mean duration was（54.1±41.2）months for 133 cases in the nonstandard group, and the duration difference between the two groups was statistically significant (t=0.340, P=0.022). 99 cases had reoperation of the lateral cervical area, including 56 with standardized initial neck dissection (standard group) and 43 with unstandardized initial dissection (nonstandard group). The average durations from initial operation to reoperation of the standard and nonstandard group were（39.3±33.8）months and（26±24.1）months respectively, and the duration difference was statistically significant (t=0.178, P=0.041).ConclusionsThe main reasons for reoperation in patients with thyroid papillary carcinoma are scope inadequacy of initial thyroidectomy and/or range insufficiency in initial lateral neck dissection. For patients with unilateral unifocal papillary thyroid carcinoma, the initial surgical procedure should be at least unilateral lobectomy plus isthmectomy with ipsilateral centralcompartment neck dissection. Bilateral lobectomy with unilateral centralcompartment neck dissection should be adopted in the initial surgical treatment for the others. In patients with neck metastasis, the initial lymph node dissection should include at least level II (IIa), III, and IV.

Key words:甲状腺乳头状癌|再次手术|初次手术