中国实用外科杂志

中国实用外科杂志

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甲状腺癌术后复发再手术中甲状旁腺和神经保护

花苏榕，廖    泉   

  1. 中国医学科学院北京协和医院基本外科，北京 100730
  • 出版日期:2021-08-01 发布日期:2021-08-10

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

摘要： 甲状腺癌是一种十分常见的恶性肿瘤，其病理类型大多数为分化型甲状腺癌，经规范化治疗，预后较好，但仍有部分病人复发，且长期随访，可有高达30%以上的复发或转移率。因此，再次手术是甲状腺外科医师不可避免的问题，甚至在未来一段时间会成为一个临床常见情况。再次手术，尤其是Ⅵ区淋巴结复发的再次手术，往往有较高的手术难度和风险，需要谨慎地选择手术时机和入路，术中应用神经监测与传统显露技术相结合以保护喉返神经，运用传统识别和保护手法，选择性应用纳米炭、甲状旁腺素试纸、近红外自体荧光显像等技术以保护甲状旁腺功能。

关键词: 甲状腺癌, 再次手术, 喉返神经, 甲状旁腺保护

Abstract: Parathyroid and nerve protection in recurrent thyroid cancer redo-surgery        HUA Su-rong, LIAO Quan. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
Corresponding author:LIAO Quan,E-mail：lqpumc@126.com
Abstract    Thyroid cancer is a common malignancy and mostly differentiated, whose prognosis is usually good if treated properly. But there are still some recurrence cases, and long-term follow-up showed a recurrence rate of up to 30%. So redo-surgery is an inevitable problem for thyroid surgeons, and it will even become a common condition in the future. Redo-surgery, especially in zone Ⅵ lymph nodes recurrence, is usually very difficult and risky. Careful choose of the surgical timing and access, the application of intraoperative nerve monitoring to protect the recurrent laryngeal nerve, the use of traditional identification and protection techniques combined with selective application of nanocarbon, parathyroid hormone assay, or near-infrared autofluorescence imaging to protect parathyroid function, is recommended.

Key words: thyroid cancer, redo-surgery, recurrent laryngeal nerve, parathyroid protection