摘要
目的 为避免二次手术,结合冰冻病理特点探讨乳头状甲状腺微小癌首次手术的合理术式.方法 随访近5年在首都医科大学附属北京天坛医院门诊复诊的乳头状甲状腺微小癌患者96例.比较患侧腺叶加峡部切除（单侧组）与患侧腺叶加峡部切除加对侧腺叶次全切除（双侧组）两种术式的转移复发率.比较中央区淋巴结清扫组（清扫组）与非清扫组（非清扫组）的转移复发率和喉返神经损伤率.结果 术中冰冻病理能够确诊为癌53例（55％）.无论高低危人群,单侧组与双侧组转移复发率差异无统计学意义（P＞0.05）.清扫组与非清扫组转移复发率在高低危人群差异均无统计学意义（P＞0.05）.清扫组的喉返神经暂时性损伤率在高危人群（P =0.040,P＜0.05）和低危人群（P =0.037,P＜0.05）均较非清扫组高.结论 乳头状甲状腺微小癌术中冰冻病理确诊难度高,首次术式合理为患侧腺叶加峡部切除.术中探查无明确淋巴转移者不作预防清扫.
Objective Investigate the reasonable surgical approach combined with frozen sections pathological features of papillary thyroid microcarcinoma.Methods Clinical data of 96 cases papillary thyroid microcarcinoma nearly 5 years of follow-up in our clinic referral was retrospectively analyzed.Metastasis and recurrence rate were compared between group of ipsilateral lobe plus isthmus resection （unilateral group） and group of ipsilateral lobe plus isthmus resection and contralateral lobe subtotal （bilateral group）.Metastasis and recurrence rate were compared between group of central lymph node dissection （dissection group） and non-dissection group （non-dissection group）,and the injury rate of the recurrent laryngeal nerve was also compared between the two groups.Results The diagnosis of cancer by intraoperative frozen pathology were 53 cases （55%）.Whether in high or low risk populations,the metastasis and recurrence between unilateral and bilateral groups showed no significant difference （P 〉 0.05）.Whether in high or low risk populations,the metastasis and recurrence between dissection group and non-dissection groups showed no significant difference （P 〉0.05）.The temporary injury rate of recurrent laryngeal nerve in dissection group were higher than thatin non-dissection group both in high-risk populations （P =0.040,P 〈 0.05） and low risk populations（P =0.037,P 〈 0.05）.Conclusions Intraoperative frozen pathological diagnosis of papillary thyroid microcarcinoma is difficult.The reasonable surgical approach for the first time is ipsilateral lobe plus isthmus resection.Preventive cervical dissections operation should not be carried out if the exploratory of lymph node showed no metastasis.
出处
《国际外科学杂志》
2015年第4期236-239,共4页
International Journal of Surgery
关键词
甲状腺肿瘤
复发
喉返神经
冷冻超薄切片术
Thyroid neoplasms
Recurrence
Recurrent laryngeal nerve
Cryoultramicrotomy
