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甲状腺滤泡状癌诊断与外科治疗的临床分析
Clinical Analysis of Diagnosis and Surgical Treatment of Follicular Thyroid Carcinoma
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DOI:
作者:
程枫,王伟斌,滕理送
CHENG Feng, WANG Wei-bin, TENG Li-song.
作者单位:
1.浙江大学医学院附属第一医院肿瘤外科,2.丽水市中心医院外科五病区(普外科)
1. Department of Oncology Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University. 2. Department of General Surgery, Lishui Central Hospital.
关键词:
甲状腺滤泡状癌;诊断;外科治疗
Follicular thyroid carcinoma; Diagnosis; Surgical treatment
摘要:
目的 探讨甲状腺滤泡状癌的诊断与外科治疗现状。方法 回顾分析我院1997-2006年间诊治的66例甲状腺滤泡状癌的临床资料。结果 本组66例均行甲状腺切除术,切除范围包括患侧部分/次全切除8例,双侧次全切除7例,患侧全切17例,患侧全切+对侧部分/次全切除26例,全甲状腺切除8例。有63例患者进行术中冰冻检查,术中确诊滤泡状癌46例,冰冻诊断符合率73.0%。有16例患者术中行颈淋巴结清扫术,包括中央区淋巴结清扫6例,侧方颈淋巴结清扫10例,术后病理证实淋巴结转移均阴性,淋巴结转移率为零。中位随访时间68个月的临床随访结果显示,2例患者(4.8%, 2/42)局部复发和3例(7.1%, 3/42)患者肺部转移,3例转移病例均在随访期内死亡。结论 甲状腺滤泡状癌的术中冰冻诊断存在难度,准确率低于其他类型甲状腺癌;滤泡状癌的淋巴结转移率极低,远处转移率较高;甲状腺全切术应作为外科初始治疗的推荐术式,而常规预防性颈淋巴结清扫不作推荐。
Objective To investigate the diagnosis and surgical treatment of follicular thyroid carcinoma(FTC) in our institution. Methods Retrospective analysis the clinical data of 66 cases of FTC treated from 1997 to 2006 in our institute. Results 66 patients in this group all underwent surgery. 8 had an ipsilateral partial/subtotal thyroidectomy, 7 had a bilateral subtotal thyroidectomy, 17 had an ipsilateral lobectomy, 26 had an ipsilateral lobectomy and Contralateral partial /subtotal thyroidectomy, 8 had total thyroidectomy. 63 patients performed intraoperative frozen section and yielded a correct diagnosis of FTC in 46 patients (73.0%,46/63). 16 patients had cervical dissection, 6 had a Central neck dissection and 10 had a Lateral neck dissection. All lymph nodes were negative of which were confirmed by pathology. During a median of 68 months following, 2 patients (4.8%, 2/42) had regional recurrence. While 3 patients (7.1%, 3/42) had pulmonary metastases and they all died of the disease. Conclusions Diagnosis of follicular thyroid carcinoma is difficult by intraoperative frozen section. The accuracy was lower than other types of thyroid cancer. Follicular thyroid carcinoma has a very low lymph node metastasis rate compared a higher rate of distant metastasis. Total thyroidectomy should be recommended for surgical initial therapy and routine prophylactic neck dissection is not recommended.
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