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目的探讨甲状腺癌首次误诊治再手术的适应证及手术方式。方法对1991-2005年分化型甲状腺癌162例首次外院术式不当再手术进行分析。结果行患侧甲状腺残叶+峡部切除者121例,行患侧甲状腺残叶+峡部切除+功能性颈淋巴结清扫术40例,双叶甲状腺癌根治术14例。再手术病理证实癌残留83例(52.86%),颈淋巴结转移38例(23.45%),随访5 a,至今均生存。结论甲状腺癌行局部肿块切除术,残癌率高,再手术是必需的。术中应常规行冰冻病理检查,是避免甲状腺癌再手术关键。
Objective To investigate the indications and surgical methods for the first misdiagnosis and treatment of thyroid cancer. Methods A total of 162 cases of differentiated thyroid cancer from 1991 to 2005 were analyzed retrospectively. Results There were 121 patients with ipsilateral thyroid gland lobectomy and isthmus excision, 40 patients with ipsilateral thyroid gland lobectomy + isthmus ablation + functional cervical lymph node dissection, and 14 patients with double lobes thyroidectomy. Re-operative pathology confirmed 83 cases of residual cancer (52.86%), cervical lymph node metastasis in 38 cases (23.45%), followed up for 5 years, so far have survived. Conclusions Local thyroidectomy with local tumor resection has high rate of residual cancer and reoperation is necessary. Surgery should be routine frozen pathological examination is the key to avoid recurrence of thyroid cancer.