Phẫu Thuật Cắt Bóc Hạch Bạch Huyết Trung Tâm Trong Ung Thư Tuyến Giáp Phân Biệt

World Journal of Surgery - Tập 31 - Trang 895-904 - 2007
Matthew L. White1,2, Paul G. Gauger1, Gerard M. Doherty1
1Department of Surgery, University of Michigan, Ann Arbor, USA
2Department of Surgery, St. Joseph Mercy Hospital, Ann Arbor, USA

Tóm tắt

Đã có sự quan tâm trở lại đối với phẫu thuật cắt bỏ hạch lympho mở rộng cho ung thư tuyến giáp dạng nhú (PTC), và một số báo cáo đã được công bố liên quan đến việc cắt bỏ hạch lympho vùng theo tổ chức cho PTC. Một đánh giá toàn diện về tài liệu này bằng phương pháp luận dựa trên bằng chứng còn đang chờ thực hiện. Đánh giá hệ thống tài liệu dựa trên các tiêu chí dựa vào bằng chứng. Vấn đề 1: Phẫu thuật cắt bỏ hạch lympho trung tâm theo tổ chức có hệ thống (CLND) có thể làm giảm nguy cơ tái phát PTC (dữ liệu cấp IV và V, không có khuyến nghị) và có khả năng cải thiện tỷ lệ sống bệnh đặc hiệu (khuyến nghị cấp C). Dữ liệu cấp III hạn chế cho thấy lợi ích về sống sót với việc thêm phẫu thuật cắt bỏ dự phòng vào phẫu thuật cắt tuyến giáp (khuyến nghị cấp C). Việc thêm CLND vào phẫu thuật cắt toàn bộ tuyến giáp có thể làm giảm đáng kể nồng độ thyroglobulin huyết thanh và tăng tỷ lệ athyroglobulinemia (dữ liệu cấp IV, không có khuyến nghị). Vấn đề 2: Có thể có tỷ lệ cao hơn về tình trạng giảm chức năng tuyến cận giáp vĩnh viễn và tổn thương thần kinh không mong muốn vĩnh viễn khi thực hiện CLND cùng với phẫu thuật cắt toàn bộ tuyến giáp so với phẫu thuật cắt toàn bộ tuyến giáp đơn thuần (khuyến nghị cấp C). Vấn đề 3: Phẫu thuật lại ở khu vực cổ trung tâm cho PTC tái phát có thể làm tăng nguy cơ giảm chức năng tuyến cận giáp và tổn thương thần kinh không mong muốn khi so sánh với phẫu thuật cắt toàn bộ tuyến giáp có hoặc không có CLND (khuyến nghị cấp C), ủng hộ một cuộc phẫu thuật ban đầu quyết liệt hơn. Các khuyến nghị dựa trên bằng chứng ủng hộ CLND cho PTC ở bệnh nhân được chăm sóc bởi các bác sĩ phẫu thuật nội tiết có kinh nghiệm.

Từ khóa

#ung thư tuyến giáp #cắt bỏ hạch lympho #phẫu thuật #thyroglobulin #phẫu thuật cắt toàn bộ tuyến giáp

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