中国实用外科杂志 ›› 2011, Vol. 31 ›› Issue (05): 371-373.

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分化型甲状腺癌初始手术规范化的思考

刘永锋   

  1. 中国医科大学附属第一医院普通外科,辽宁沈阳110001
  • 出版日期:2011-05-01 发布日期:2011-05-30

  • Online:2011-05-01 Published:2011-05-30

摘要:

分化型甲状腺癌初始手术治疗的规范化是改善病人预后的关键因素。对于分化型甲状腺癌的原发灶切除范围,废弃小于一侧腺叶的手术方式已达成共识,分歧在于是否应对所有病例均行全甲状腺切除或近全甲状腺切除术。关于颈淋巴结清扫术,推荐在根治原发灶的基础上常规行Ⅵ区淋巴结清扫术,改良型颈淋巴结清扫术用于cN1 病例已是共识,要坚持大块切除的原则,杜绝淋巴结“摘除术”,但对cN0病例是否进行颈淋巴结清扫还存在分歧, 目前不做选择性颈淋巴结清扫术的观点占主流。对周围器官受侵的病例,要注意保护重要器官的功能。

关键词: 分化型甲状腺癌, 颈淋巴结清扫, 甲状腺切除术

Abstract:

Advocating the normalization of initial surgical treatment in differentiated thyroid cancer        LIU Yong-feng. Department of General Surgery, the First Hospital of China Medical University, Shenyang 110001, China
Abstract    The standardized initial surgical treatment is the key point to improve prognosis in differentiated thyroid cancer patients. For most patients with differentiated thyroid cancer, the smallest extent of excision should be thyroid lobectomy. The divergence is whether near-total or total thyroidectomy should be performed in all patients. Routine central-compartment neck dissection should be considered for patients with differentiated thyroid cancer. Lateral neck compartmental lymph node dissection should be performed for clinical N1 patients. Functional compartmental en-bloc dissection is favored over selective dissection (berry picking).Prophylactic lateral neck compartmental lymph node dissection is not recommended in clinical N0 patients. The protection of organ function should be stressed in differentiated thyroid cancer patients with organ invasion.

Key words: differentiated thyroid cancer, neck dissection, thyroidectomy