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題 名 | 以側頸腫塊表現之甲狀腺乳頭狀癌=Papillary Thyroid Cancer Presented as Lateral Neck Mass |
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作 者 | 吳政德; 朱本元; 張學逸; | 書刊名 | 中華民國耳鼻喉科醫學會雜誌 |
卷 期 | 33:4 1998.08[民87.08] |
頁 次 | 頁67-74 |
分類號 | 415.931 |
關鍵詞 | 甲狀腺乳頭狀癌; 側頸腫塊; Papillary thyroid carcinoma; Lateral neck mass; |
語 文 | 中文(Chinese) |
中文摘要 | 背景:甲狀腺腫瘤通常以前頸部腫塊表現為主,但有部份甲狀腺乳頭狀癌 其原發部位並不明顯,而僅以側頸腫塊表現,以致於常被人忽視。這類僅以側頸腫塊表現, 而原發位置卻觸摸不到任何腫塊的甲狀腺乳頭狀癌,其處理方式和一般甲狀腺乳頭狀癌是否 有不同,預後是否有差異,正是本研究所探討的重點。 方法:從 1986 年 8 月至 1995 年 7 月我們共經歷了 22 例這類病患, 依其臨床表徵、治療方法及預後加以分析。 結果:在 22 例病患中,有 13 例女性,9 例男性,平均追蹤 44 個月。 大部分病例診斷為轉移性甲 狀腺乳頭狀癌都是藉手術後病理切片告得知。 治療方式在甲狀腺方面: 全甲狀腺切除術有 15 例,次全甲狀腺切除術有 5 例,僅做同側甲狀腺切除有 2 例; 在頸部淋巴方面:根治 性頸廓清術有 3 例,改良性頸廓清術有 16 例,單一淋巴結摘除有 3 例。術後追蹤:局部 復發有 2 例;頸部淋巴復發有 3 例;遠處轉移有 1 例;僅 1 例死亡。在所有 22 例中, 術後併發症有 3 例,都是接受全甲狀腺切除術者。 結論:我們認為這類甲狀腺乳頭狀癌較 一般未產生頸部轉移的甲狀腺乳頭狀癌,更具侵犯性。原發位置宜施行全甲狀腺切除術,頸 部淋巴宜施行改良性頸廓清術,即可達到較好的控制。 |
英文摘要 | Background: Many diseases present as lateral neck masses and differential diagnosis requires precise examination. In some case final diagnosi may be papillary thyroid carcinoma with neck lympy nodes metastasis, a possibility often ignored by clinicians. On initial evaluation, this form of papillary thyroid cancer merely presents as a lateral neck mass and otherwise appears as a normal thyroid. We are interested in the differences between the different types of papillary thyroid cancers in view of therapy and prognosis. Methods: We collected 22 cases of metastatic papillary thyroid cancer presented solely as lateral neck mass and analyzed these cases in detail. Results: In the management of thyroid glands of these 22 cases, 15 received total thyroidectomy, 5 received subtotal thyroidectomy, and 2 received ipsilateral lobectomy. In the management of neck pathology of these 22 cases, 3 received classical redical neck dissection. 16 received modified radical neck dissection. and 3 cases received simple lymph node excision. In the postoperative follow-up periods, 2 showed local recurrence, 3 showed neck regional lymph nodes ecurrence, 1 showed distant metastasis, and 1 died of the disease. In these 22 cases, 3 suffered from postoperative complications in which all received total thyroidectomy initially. Conclusions: Thyroid carcinoma presenting as a regional neck mass had a greater lymph node recurrence rate (13.6%) than that without neck lymph nodes metastasis. The disease entity also had a more aggressive behavior. Aggressive initial surgical procedure consisting of total thyroidectomy with modified raqdical neck dissection is recommended for lowering the morbidity and local and regional recurrence rate of these patients. |
本系統中英文摘要資訊取自各篇刊載內容。