甲状腺滤泡状癌诊断与外科治疗的临床分析.docVIP

甲状腺滤泡状癌诊断与外科治疗的临床分析 程枫1,2 王伟斌1 滕理送1 1.浙江大学医学院附属第一医院肿瘤外科，杭州，310003； 2.丽水市中心医院普外科，浙江，323000 【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。63例患者进行术中冰冻检查，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)肺部转移，3例转移病例均在随访期死亡。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。 【关键词】 甲状腺滤泡状癌；诊断；外科治疗 Diagnosis and Surgical Treatment of Follicular Thyroid Carcinoma CHENG Feng1,2, WANG Wei-bin1, TENG Li-song1 1. Department of Surgical Oncology, First Affiliated Hospital of Zhejiang University, School of Medicine. Hangzhou 310003, China. 2. Department of General Surgery, Lishui Central Hospital, Zhejiang 323000, China. 第一作者程枫, 浙江大学医学院附属第一医院硕士研究生，现在丽水市中心医院普外科工作。电话电子邮箱：kaede474@。 通讯作者滕理送，肿瘤学教授，博士生导师，浙江大学医学院附属第一医院肿瘤中心主任（兼肿瘤外科主任），浙江省医学会肿瘤学分会副主任委员。电子邮箱：lsteng@。 本项研究受浙江省卫生厅课题资助（项目编号2012RCB016） [Abstract] 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