Abstract:

Reasonable choice of surgical treatment for thyroid nodule        ZHU Jing-qiang，SU An-ping. Department of Thyroid and Breast Surgery，West China Hospital，Sichuan University，Chengdu 610041，China
Corresponding author：ZHU Jing-qiang，E-mail：zjq-wkys@163.com
Abstract    Most of thyroid nodule only need to be under observasion. Surgical treatments，which are determined by certain clinical，radiographic，cytologic features and evidence-based medicine，are performed on few benign nodules and most malignant nodules. The choice of surgical procedures should take into account standard，safety and totality，which could effectively decrease the incidence of reoccurrence and reoperation. The surgical treatments for thyroid nodules include thyroidectomy and lymph node dissection. The standard surgical procedures include lobectomy，near total resection and total resection. Lobectomy is the smallest surgical procedure for thyroid nodules. It has reached a consensus that prophylactic lymph node dissection is not performed on follicular thyroid cancer and lateral lymph node. Central lymph node dissection should be performed routinely on papillary thyroid cancer. Bilateral central lymph node dissection and ipsilateral lymph node dissection should be performed on medullary thyroid cancer.

Key words: thyroid nodule, thyroid cancer, surgical indication, thyroidectomy, cervical lymph node dissection

摘要：

大部分结节仅需要随访，只有少数良性结节和绝大多数恶性结节才需要手术治疗。甲状腺结节手术指征应综合病人的症状、体征、影像学检查、病理学资料，依据循证医学证据而制定。手术方式的选择应充分兼顾规范性、安全性及彻底性，有效减少病变复发（或再发）及再次手术。甲状腺手术包括甲状腺切除及颈淋巴结清扫。规范的甲状腺术式包括甲状腺腺叶切除及全（近全）切除。腺叶切除是最小术式。甲状腺滤泡状癌及颈侧区只行治疗性淋巴结清扫在国内外业界内已达成共识。甲状腺乳头状癌宜常规行患侧中央区淋巴结清扫。甲状腺髓样癌宜行双侧中央区及患侧颈侧区淋巴结清扫。

关键词: 甲状腺结节, 甲状腺癌, 手术指征, 甲状腺切除, 颈淋巴结清扫