甲状腺癌126例诊治分析.docVIP

甲状腺癌126例诊治分析 　　【摘要】目的 总结甲状腺癌的诊治经验。方法 分析我院2001～2010年间手术治疗并经常规病理切片证实的126例甲状腺癌的临床资料:男32例，女94例，平均年龄43岁(年龄范围:13～85岁)。结果 甲状腺乳头状癌，滤泡癌，髓样癌，未分化癌发病率分别为71%(90例)，14%(18例)，11%(14例，5%（4例）。无手术死亡，术后声音嘶哑4例，因气管压迫行气管切开2例，伴桥本氏病4例，经病理证实再次手术10例。结论 对甲状腺肿物患者应综合病史、查体、B超、CT、ECT、细针穿刺细胞学检查等，适当放宽手术适应症，有条件的医院常规行术中冰冻检查，对不能做冰冻检查或冰冻阴性却高度怀疑恶性病者，建议行患侧腺叶加峡部切除，避免二次手术增加患者痛苦及手术并发症的发生。建议对发现颈淋巴结肿大或双侧恶性变者均行根治术加颈清扫术，未发现颈淋巴结肿大者，行患叶甲状腺及峡部全切加对侧大部分切除术加气??前清扫术。对已行甲状腺局部切除术者，应尽快行补救的根治术加或不加颈清扫术。甲状腺癌以PTC常见，且预后较好，MTC及未分化癌手术应以全甲状腺切除术加颈淋巴结清扫术。早期诊断，早期治疗，适当的手术方法，是提高疗效的关键。 　　【关键词】甲状腺癌 分化良好型 分化不良型 诊断 治疗 　　中图分类号：R736.1 文献标识码：A 文章编号：1005-0515（2012）2-010-02 　　The analysis of 126 thyroid carcinomas 　　MA Kanggui1 ZHEN He TANG Weizhe 　　（General Surgery of theCcentral Hospital， Shaoyang， Hunan， China 422000） 　　【Abstract】Objective To summarize the experiences of treating thyroid carcinoma. Methods Analysis the 126 thyroid carcinomas diagnosised by the pathological section from 2001 to 2010 in our hospital. Male 32 cases, female 94 cases, mean age 43 years old (from 13 to 85 ) .Results Thyroid papillary carcinoma 90 cases (71%), follicle carcinoma 18 cases (14%), medullary carcinoma 14 cases (11%),and undifferentiated carcinoma 4 cases(5%). All survival and Complications: 4 hoarse voices, 2 trachea compressions, 4 combind Hashimoto thyroiditis, and 10 reoperations. Conclusions Treating patients who have thyroid goitre, we should consider their histories, physical examinations, inspects by instrument (such as supersonic, CT, ECT, and cytological examination), and we should expand their operation indication. We should do conventional freezing pathology examination during the opration in conditional hospital; If not， we should cut the sick side and the isthmus for the highly sceptical bad-goitres. For the deradenoncus cases of thyroid carcinoma, we should do the radical neck dissection, besides cut sick side thyroid or two; for the others, cut the sick gland and isthmus and scavenge the lymph nodes which are in front of the tra