甲状腺癌诊治规范化的探讨
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中国医学科学院中国协和医科大学肿瘤医院头颈外科 唐平章
【摘要】 目的 寻找治疗甲状腺癌的最佳措施，以提高患者的生存率，降低局部复发率。 方法 复习文献，结合我院的治疗经验。 结果 超声诊断甲状腺癌的准确率可达 85% 。分化型甲状腺癌的多中心病灶为 30% 左右；一侧腺叶切除后对侧复发几率为 5%~15% 。我们的资料一侧腺叶切除后对侧复发不足 6% 。甲状腺癌外院部分切除术后再手术，患者肿瘤残存率为 52.5% ，其中原发部位残癌率为 42.5% ，患侧颈部 VI 区转移淋巴结残留率为 28.1% ，患侧颈部转移淋巴结残留率为 35.4% 。甲状腺乳头状癌颈部淋巴结转移率为 60.9% ，甲状腺髓样癌颈部淋巴结转移率为 80% 左右。甲状腺乳头状癌颈部淋巴结转移患者的 5 年和 10 年生存率分别为 84.3% 和 80.4% ，而临床颈部阴性术后出现颈部淋巴结转移在行颈清扫患者的 5 年和 10 年生存率分别为 91.4% 和 82.2% 。甲状腺癌纵隔淋巴结转移手术后，其总的 5 年和 10 年累积生存率分别为 64.56% 和 63.09% 。 结论 超声有助于诊断甲状腺肿瘤的性质。对分化型甲状腺癌，手术是主要的治疗措施，对原发灶主张一侧腺叶加峡部切除，反对部分切除和全甲状腺切除；对颈部淋巴结临床阳性患者，应给予淋巴结清扫，反对预防性颈淋巴结清扫。对甲状腺未分化癌，手术不是主要的治疗措施，而是为了明确诊断、解决呼吸困难，确诊后应给予放射治疗。
【关键词】 甲状腺； 癌； 治疗
【 Abstract 】 Objective To explore the best therapeutic measure for thyroid carcinoma, so as to improve the survive rate and cut down the local recurrence rate. Methods To combine the document and therapeutic experience about thyroid carcinoma at our hospital. Results The accuracy rate of ultrasound diagnosis for thyroid carcinoma was 85%. The multi-focus for differentiated thyroid carcinoma was 30%,the contralateral thyroid lobe recurrence rate for the thyroid lobectomy was 5%-15%.Our date showed the contralateral thyroid lobe recurrence rate for the thyroid lobectomy was below 6%. The repeated operation at our hospital was performed for partial thyroid lobe or lesion excision at other hospital, the remnant rate of tumor was 52.5%,in which the remnant rate for the primary lesion was 42.5%, the remnant rate for VI level was 28.1%, the remnant rate for the ipsilateral neck was 35.4%. The rate of ipsilateral neck lymph node metastesis was 60.9% for papillary thyroid carcinoma, The rate of ipsilateral neck lymph node metastesis was 80% for medullary thyroid carcinoma.The 5- and 10-year survive rate was 84.3% and 80.4% respectively for papillary thyroid carcinoma with neck lymph node metastesis, but the 5- and 10-year survive rate was 91.4% and 82.2% respectively for the patients with cN0 in whom the neck dissection were perfomed after neck recurrence. The 5- and 10-year accumulate survive rate was 64.56% and 63.59% respectively for the patients with mediastinal lymph node metastesis in whom the mediastinal lymph node dissection were perfomed. Conclusion Ultrasound is helpful to the diagnosis of thyroid tumor. For the differentiated thyroid carcinoma,surgery is the first choice of therapeutic measure; the thyroid lobectomy and isthmus excision is advocated for the primary lesion, and partial or total thyroidectomy should be opposed;the neck dissection should be considered for the patient with neck lymph node metastesis, the preventive neck dissection should be opposed for the patient with cN0. For the undifferentiated thyroid carcinoma, operation is not the first choice of therpeutic measure,but it is to obtain the histopathology diagnosis and solve dyspnea, radiotherapy should be considered in case the diagnosis is established.
【 Key words 】 Thyroid ； Carcinoma ； Therapy
甲状腺肿瘤的发病率较高 ......
中国医学科学院中国协和医科大学肿瘤医院头颈外科 唐平章
【摘要】 目的 寻找治疗甲状腺癌的最佳措施，以提高患者的生存率，降低局部复发率。 方法 复习文献，结合我院的治疗经验。 结果 超声诊断甲状腺癌的准确率可达 85% 。分化型甲状腺癌的多中心病灶为 30% 左右；一侧腺叶切除后对侧复发几率为 5%~15% 。我们的资料一侧腺叶切除后对侧复发不足 6% 。甲状腺癌外院部分切除术后再手术，患者肿瘤残存率为 52.5% ，其中原发部位残癌率为 42.5% ，患侧颈部 VI 区转移淋巴结残留率为 28.1% ，患侧颈部转移淋巴结残留率为 35.4% 。甲状腺乳头状癌颈部淋巴结转移率为 60.9% ，甲状腺髓样癌颈部淋巴结转移率为 80% 左右。甲状腺乳头状癌颈部淋巴结转移患者的 5 年和 10 年生存率分别为 84.3% 和 80.4% ，而临床颈部阴性术后出现颈部淋巴结转移在行颈清扫患者的 5 年和 10 年生存率分别为 91.4% 和 82.2% 。甲状腺癌纵隔淋巴结转移手术后，其总的 5 年和 10 年累积生存率分别为 64.56% 和 63.09% 。 结论 超声有助于诊断甲状腺肿瘤的性质。对分化型甲状腺癌，手术是主要的治疗措施，对原发灶主张一侧腺叶加峡部切除，反对部分切除和全甲状腺切除；对颈部淋巴结临床阳性患者，应给予淋巴结清扫，反对预防性颈淋巴结清扫。对甲状腺未分化癌，手术不是主要的治疗措施，而是为了明确诊断、解决呼吸困难，确诊后应给予放射治疗。
【关键词】 甲状腺； 癌； 治疗
【 Abstract 】 Objective To explore the best therapeutic measure for thyroid carcinoma, so as to improve the survive rate and cut down the local recurrence rate. Methods To combine the document and therapeutic experience about thyroid carcinoma at our hospital. Results The accuracy rate of ultrasound diagnosis for thyroid carcinoma was 85%. The multi-focus for differentiated thyroid carcinoma was 30%,the contralateral thyroid lobe recurrence rate for the thyroid lobectomy was 5%-15%.Our date showed the contralateral thyroid lobe recurrence rate for the thyroid lobectomy was below 6%. The repeated operation at our hospital was performed for partial thyroid lobe or lesion excision at other hospital, the remnant rate of tumor was 52.5%,in which the remnant rate for the primary lesion was 42.5%, the remnant rate for VI level was 28.1%, the remnant rate for the ipsilateral neck was 35.4%. The rate of ipsilateral neck lymph node metastesis was 60.9% for papillary thyroid carcinoma, The rate of ipsilateral neck lymph node metastesis was 80% for medullary thyroid carcinoma.The 5- and 10-year survive rate was 84.3% and 80.4% respectively for papillary thyroid carcinoma with neck lymph node metastesis, but the 5- and 10-year survive rate was 91.4% and 82.2% respectively for the patients with cN0 in whom the neck dissection were perfomed after neck recurrence. The 5- and 10-year accumulate survive rate was 64.56% and 63.59% respectively for the patients with mediastinal lymph node metastesis in whom the mediastinal lymph node dissection were perfomed. Conclusion Ultrasound is helpful to the diagnosis of thyroid tumor. For the differentiated thyroid carcinoma,surgery is the first choice of therapeutic measure; the thyroid lobectomy and isthmus excision is advocated for the primary lesion, and partial or total thyroidectomy should be opposed;the neck dissection should be considered for the patient with neck lymph node metastesis, the preventive neck dissection should be opposed for the patient with cN0. For the undifferentiated thyroid carcinoma, operation is not the first choice of therpeutic measure,but it is to obtain the histopathology diagnosis and solve dyspnea, radiotherapy should be considered in case the diagnosis is established.
【 Key words 】 Thyroid ； Carcinoma ； Therapy
甲状腺肿瘤的发病率较高 ......
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