Nội dung được dịch bởi AI, chỉ mang tính chất tham khảo
Vai trò của phẫu thuật trong quản lý hiện tại ung thư tuyến giáp phân biệt
Tóm tắt
Trong vài thập kỷ qua, đã quan sát thấy sự gia tăng đáng ngạc nhiên về tỷ lệ mắc ung thư tuyến giáp phân biệt (DTC), cùng với việc chẩn đoán sớm các khối u "nhỏ" và viễn cảnh khối u. Trong những trường hợp này, kỳ vọng về kết quả ung thư tốt hơn là điều thường thấy, và một giao thức điều trị đa phương thức "được điều chỉnh" và "cách tiếp cận ít hung hãn hơn" nên được xem xét, nhằm tránh những biến chứng không mong muốn ngay cả khi tối thiểu sau một lần "điều trị quá". Để xác định tốt hơn phương pháp phẫu thuật phù hợp nhất, cùng với những lợi ích và rủi ro của nó, chúng tôi thảo luận về vai trò của phẫu thuật trong việc quản lý hiện tại các DTC dựa trên dữ liệu đã xuất hiện trong tài liệu. Dù di căn hạch bạch huyết thường được quan sát và có tới 90% trường hợp DTC được báo cáo có vi di căn, ảnh hưởng của việc tham gia bạch huyết đến lâu dài sống sót vẫn đang là chủ đề của nghiên cứu sâu rộng, và chỉ định cùng mức độ cắt bỏ hạch bạch huyết (LD) vẫn đang tranh luận. Đặc biệt, các bác sĩ phẫu thuật nội tiết và cổ vẫn bị chia rẽ giữa những người ủng hộ và phản đối cắt bỏ hạch bạch huyết trung tâm định kỳ (RCLD). Xét về bằng chứng hiện có, có sự đồng thuận về cắt bỏ tuyến giáp hoàn toàn, cắt bỏ hạch bạch huyết điều trị ở bệnh nhân DTC có hạch dương tính lâm sàng, và RCLD ở các trường hợp "nguy cơ cao". Tuy nhiên, các chỉ định cho điều trị phẫu thuật tốt nhất đối với bệnh nhân "nguy cơ thấp" âm tính chưa được nghiên cứu đầy đủ. Xét trên một mặt, xu hướng gần đây về cắt bỏ hạch bạch huyết trung tâm định kỳ, tránh điều trị phóng xạ, và mặt khác, các kết quả khả quan đạt được khi chỉ định cắt bỏ hạch bạch huyết phòng ngừa cho bệnh nhân "nguy cơ cao", chúng tôi cho rằng cần có thêm các thử nghiệm ngẫu nhiên có triển vọng để đánh giá lựa chọn tốt nhất giữa các phương pháp phẫu thuật khác nhau.
Từ khóa
#ung thư tuyến giáp phân biệt #phẫu thuật #cắt bỏ hạch bạch huyết #điều trị đa phương thức #vi di căn #nguy cơ cao #hạch bạch huyếtTài liệu tham khảo
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