76例分化型甲状腺癌手术方式及诊断的临床分析

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1、76例分化型甲状腺癌手术方式及诊断的临床分析【摘要】目的：探讨分化型甲状腺癌的诊断和手术方式。方法：对本院2010年1月-2013年12月收入院后经手术治疗的分化型甲状腺癌76例的临床资料进行回顾性分析。其中合并结节性甲状腺肿18例，甲状腺腺瘤5例，桥本氏甲状腺炎3例，原发性甲亢1例。结果：术中冰冻切片诊断68例，阳性率为89.47%o术后病理报告乳头状癌69例(90.79%),滤泡样癌7例(9.21%)，伴有区域淋巴结转移47例(61.83%),肿瘤浸润包膜13例(17.11%)，其中浸出包膜外9例(11

2、.84%)。手术方式主要采取患侧腺叶、峡部切除及对侧腺叶次全切除、颈部淋巴结清扫术或甲状腺全切、颈部淋巴结清扫术。术后甲状腺功能减退5例，声音嘶哑9例(7例为暂时性，2例为永久性)，7例低钙抽搐或肢端麻木。全部病例获随访，局部复发者12例，颈部淋巴结复发者5例，远处转移者3例。结论：术中冰冻切片检查有助于甲状腺癌的诊断及手术方式选择，分化型甲状腺癌应根据病理组织类型、肿瘤大小、病变范围、年龄和颈部淋巴结转移选择不同手术方式。【关键词】甲状腺癌；手术方式；术中冰冻切片【Abstract]Objective:T

3、oinvestigatethediagnosisandsurgicalselectionindifferentiatedthyroidcarcinoma.Method:Clinicaldataof76differentiatedthyroidcarcinomaswereanalyzedretrospectivelyfromJanuary2010toDecember2013.18caseswerecarcinomawithnodulargoiter,5caseswerecarcinomawiththyroid

4、adenoma,3caseswerecarcinomawithhashimotothyroiditis,1casewascarcinomawithhyperthyroidism.Result：68patients(89.47%)werediagnosedaccordingtointraoperativefastfrozensection.69cases(90.79%)wereapprovedpapillarythyroidcarcinoma,7cases(9.21%)werefollicularthyroi

5、dcarcinoma.Especiallyinsideofdiolameinvasionin13patients(17.11%)andoutsideofdiolameinvasionin9patients(11.84%).Neckdissectionwasperformedin64patients,and47ofthem(61.83%)hadcervicallymphnodemetastasis.Thevariousstylesofthyroidectomywereperformed,7casesshowe

6、dtemporaryvocalcordparalysis,2casesshowedpermanentafteroperation；7caseshadconvulsionorlimbsnumbnessduetohypocalcemia,and5caseshadthyroidfunctiondecrease.Followupofallcasesshowedlocalrecurrencein12patients,cervicallymphnoderecurrencein5patientsanddistantmet

7、astasisin3patients.Conclusion：Intraoperativefastfrozensectionishelpfulforthediagnosisandthechoiceofoperationmethod.Thevarioussurgicalselectionofthyroidectomyareperformedaccordingtothedifferentpathologicaltypes,tumortype，pathologicalchangesscope,ageandcervi

8、callymphnodemetastasis.【Keywords]Thyroidcarcinoma；Surgicalselection；IntraoperativefastfrozensectionFirst-author^saddress：TheAffiliatedHospitalofMedicalCollegeofJiayingUniversity,Meizhou514031，Chinadoi：10.3969