中国实用外科杂志

中国实用外科杂志

• 普通外科进展（2000-2020） • 上一篇    下一篇

分化型甲状腺癌外科诊疗进展及展望

田    文，郗洪庆   

  1. 中国人民解放军总医院第一医学中心普通外科，北京100853 
  • 出版日期:2020-01-01 发布日期:2020-01-16

  • Online:2020-01-01 Published:2020-01-16

摘要： 甲状腺癌是最常见的内分泌恶性肿瘤，近年来，发病率呈明显上升趋势。90%以上的甲状腺癌为分化型甲状腺癌（DTC），其治疗主要采取外科手术为主的多学科综合治疗协作组（MDT）模式。手术切除和淋巴结清扫范围的规范化，术中神经监测技术、甲状旁腺保护技术、颈部无瘢痕美容手术等新技术的开展和规范化应用，推动了甲状腺癌外科治疗的精细化、微创化，极大提升了安全性和治疗效果。通过早期发现和精准手术治疗，术后规范化长期随访，动态观察病情进展，及时调整治疗方案，尤其是对复发甲状腺癌再手术病人，可以进一步提高存活率和术后生存质量。对DTC发病机制深入探讨及关键调控基因靶点的研究，使更具有针对性的靶向药物应用于晚期甲状腺癌病人的治疗，为其争取了手术机会。医疗大数据、人工智能诊治系统的研发为甲状腺癌的精准诊治提供了新的技术和思路。建立系统化、智能化随访管理平台，可更加科学地开展术后规范化管理及评价临床治疗的有效性和安全性。

关键词: 甲状腺癌, 规范化, 术中神经监测, 甲状旁腺保护, 靶向药物

Abstract: Current status and future perspectives in differentiated thyroid cancer        TIAN Wen，XI Hong-qing. Department of General Surgery，the First Medical Center of Chinese People’s Liberation Army General Hospital，Beijing 100853，China
Corresponding author：TIAN Wen，E-mail：tianwen301_cta01@163.com
Abstract    Thyroid cancer is one of the most common endocrine tumors，and its incidence is increasing. More than 90% of thyroid cancer is differentiated thyroid cancer (DTC). This type of thyroid cancer is mainly treated by multidisciplinary comprehensive treatment mode based on surgery. The standardization of surgical operation and lymph node dissection，the innovative development and standardized application of new technologies such as intraoperative nerve monitoring technology，parathyroid protection technology，and neck scar free cosmetic surgery have greatly promoted the surgical treatment level of thyroid cancer to be greatly improved，and the operation is more precise，minimally invasive and safe. Through the early detection and precise surgical treatment of thyroid cancer，standardized long-term follow-up，dynamic observation of the progress of the disease，timely adjustment of the treatment plan，especially for the reoperation of recurrent thyroid cancer patients，the survival rate and quality of life of thyroid cancer will be further improved. Further study on the pathogenesis of DTC and the key regulatory gene target，more targeted drugs applied to the treatment of patients with advanced thyroid cancer，and created opportunities for operation of advanced thyroid cancer. The development of big data and artificial intelligence diagnosis and treatment system for thyroid cancer can provide new technologies and ideas for the accurate diagnosis and treatment of thyroid cancer. The establishment of systematic and intelligent follow-up management platform can more scientifically carry out standardized management and evaluate the effectiveness and safety of clinical treatment.

Key words: thyroid cancer, standardization, intraoperative neural monitoring, parathyroid protection, targeted medicine