中国实用外科杂志

中国实用外科杂志

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T1-2N0M0期甲状腺癌行全甲状腺切除加中央区淋巴结清扫必要性探讨

李红强，马润声，唐艺峰，苌群刚，王龙龙，殷德涛   

  1. 郑州大学第一附属医院甲状腺外科 河南省高等学校临床医学重点学科开放实验室，河南郑州 450052
  • 出版日期:2021-08-01 发布日期:2021-08-10

  • Online:2021-08-01 Published:2021-08-10

摘要： 目的    分析T1-2N0M0期分化型甲状腺癌不同治疗术式的肿瘤复发再手术率，探讨全甲状腺切除加中央区淋巴结清扫的必要性。方法    回顾性分析2020年4月至2021年4月郑州大学第一附属医院甲状腺外科228例术前评估为T1-2N0M0期，行全甲状腺切除加中央区淋巴结清扫的分化型甲状腺癌病人临床资料。参考2015美国甲状腺协会（ATA）分化型甲状腺癌诊疗指南，评估如果选择行腺叶切除术或全甲状腺切除术，而不行中央区淋巴结清扫，可能出现肿瘤复发的情况，并统计复发再手术率。结果    如果选择行全甲状腺切除术不加中央区淋巴结清扫，肿瘤复发再手术率35.2%（19/54）；如果选择行腺叶切除术不加中央区淋巴结清扫，肿瘤复发再手术率32.7%（54/165）；两者总体肿瘤复发再手术率为33.3%（73/219）。结论    选择T1-2N0M0期分化型甲状腺癌手术方式时，参考ATA分化型甲状腺癌诊疗指南可能会缩小手术范围，增加肿瘤复发再手术率。选择手术方式时应做好充分的术前评估，根据肿瘤大小、包膜侵犯和淋巴结转移情况，保证喉返神经及甲状旁腺安全前提下选择更加合理的治疗术式。

关键词: 分化型甲状腺癌, 全甲状腺切除术, 腺叶切除术, 复发

Abstract: Discussion on the necessity of total thyroidectomy and central lymph node dissection in differentiated thyroid carcinoma with stage T1-2N0M0        LI Hong-qiang, MA Run-sheng, TANG Yi-feng, et al. Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University; Key Discipline Laboratory of Clinical Medicine of Henan, Zhengzhou 450052,China
Corresponding author: YIN De-tao, E-mail：detaoyin@zzu.edu.cn
Abstract    Objective    To evaluate the tumor recurrence and reoperation rate of differentiated thyroid carcinoma with stage T1-2N0M0 via different surgical options, and discuss the necessity of total thyroidectomy and central lymph node dissection. Methods    A total of 228 cases of T1-2N0M0 differentiated thyroid carcinoma who underwent total thyroidectomy and central lymph node dissection in the First Affiliated Hospital of Zhengzhou University from April 2020 to April 2021 were retrospectively analyzed. The recurrence and reoperation rate of other alternative surgical options (including unilateral lobectomy and total thyroidectomy) was evaluated refer to 2015 the American thyroid association reference guidelines. Results    The recurrence and reoperation rate of thyroid tumor of total thyroidectomy is 35.2% (19/54), the recurrence and reoperation rate of thyroid tumor of unilateral lobectomy is 32.7% (54/165). The total recurrence and reoperation rate was 33.3% (73/219). Conclusion    When choosing the surgical method for stage T1-2N0M0 differentiated thyroid cancer, narrowing the surgical scope according to the guidelines may increase the rate of tumor recurrence and reoperation. When choosing the surgical method, adequate preoperative evaluation should be done according to the tumor size, capsule invasion and lymph node metastasis. To ensure the safety of recurrent laryngeal nerve and parathyroid gland under the premise of the selection of appropriate treatment.

Key words: differentiated thyroid carcinoma, total thyroidectomy, unilateral lobectomy, recurrence