15例双侧分化型甲状腺癌治疗分析.docVIP

15例双侧分化型甲状腺癌治疗分析 作者：张家新，曹苏生，王伟，刘军，鹿存涛 【摘要】 目的 探讨双侧分化型甲状腺癌的手术方式及综合 治疗 。方法 回顾经治的15例双侧分化型甲状腺癌患者的病例资料,15例行甲状腺全切术，9例同时行两侧改良颈清扫,6例行一侧改良颈清扫，3例二期行对侧颈淋巴结改良清扫术。15例患者行2～7次131放疗。结果 13例未出现复发转移，1例肺转移，1例颈部复发伴有肺部转移。结论 甲状腺全切加上有淋巴结转移侧的改良颈清扫配合131放疗是治疗双侧分化型甲状腺癌的可行方法。 【关键词】 甲状腺癌，双侧；手术；疗效 Abstract: Objective To investigate the operation modes and comprehensive treatment of bilateral differentiated thyroid carcinoma. Methods The clinical data of 15 patients of differentiated thyroid carcinoma were reviewed retrospectively. Apart from total thyroidectomy in all the cases, 9 cases underwent bilateral modified radical neck dissection and 6 cases underwent unilateral modified radical neck dissection simultaneously and 3 cases underwent second-stage contralateral modified radical neck dissection. All the patients were administered postoperative radioiodine 131Ⅰ therapy for 2-7 times. Results Postoperative follow-up of 2 to 5 years showed that there was no recurrence or metastasis in 13 patients, 1 case was found to have lung metastasis and 1 case had neck recurrence and lung metastasis. Conclusion Total thyroidectomy plus modified radical neck dissection in lymphatic metastasis in combination with postoperative radioiodine 131Ⅰ therapy proves to be a practicable method in the treatment of bilateral differentiated thyroid carcinoma. Key words: bilateral differentiated thyroid carcinoma；clinic analysis 甲状腺两侧叶在同一时期发生癌肿称同时性癌或同步性癌。双侧分化型甲状腺癌治疗较单侧要复杂，包括手术及术后的综合治疗，我院2002—2007年采用手术及131和甲状腺制剂共治疗了15例患者，取得了较为满意的效果，现 总结 如下。 1 临床资料 1.1 一般资料 本组15例,女性13例, 男性2例,年龄25～62岁。均以甲状腺包块和（或）颈淋巴结肿大就诊,2例为颈淋巴结活检发现甲状腺癌转移，发现肿块时间2个月～9年。7例双侧甲状腺可触及包块,8例单侧甲状腺可触及包块。双侧颈淋巴结肿大者3例,单侧肿大者12例,淋巴结黄豆至蚕豆大小不等,质硬,多为数枚可活动或融合。所有病例B超或CT提示双侧甲状腺肿块，单侧或双侧多个淋巴结肿大。术前均经过细针穿刺确诊为甲状腺癌。胸片未示肺转移,核素扫描无骨转移。 1.2 手术方式 15例均行甲状腺全切术，9例行两侧改良颈清扫,6例一侧改良颈清扫;6例中3例因术后病理怀疑有对侧甲状腺包膜外侵犯或颈部淋巴结转移而在3个月后行二期对侧淋巴结清扫术。 1.3 术后并发症及病理检查结果 本组病例无一例死亡,术后3例出现暂时性声嘶,出院前恢复正常；2例出现一过性的手足麻木，2天后恢复正常，检测甲状旁腺素均正常，此2例均为再次手术者。术后病理检查示乳头状癌11例,滤泡状癌4例。 1.4 131治疗及结果 所有患者术后3周（忌碘饮食及含碘药物）开