Recently, a ward of Zhengzhou People's Hospital, a patient with thyroid cancer was admitted to . After about 3 hours of surgery, the doctor successfully performed bilateral thyroidectomy, bilateral recurrent laryngeal nerve exploration, lymph node dissection in the left cervical area II, III, IV and V, and lymph node dissection in the right cervical area VI. At present, the patient has recovered well after surgery and has been discharged from the hospital.
A woman found thyroid cancer in her physical examination. The doctor took out 36 lymph nodes
It is reported that the patient Ms. Li (pseudonym) accidentally discovered thyroid nodules during the physical examination. The color ultrasound of the thyroid gland showed that: nodules were performed in the middle and upper part of the left lobe of the thyroid with clustered calcification (TI-RADs level 4), solid cystic solid nodules (TI-RADs level 3) on both sides of the thyroid lobe, and enlarged lymph nodes in the IV area of the left neck. The doctor suggested that Ms. Li undergo surgery.
Zhengzhou People's Hospital General Side 1 (hernia and abdominal wall, thyroid surgery) immediately organized a surgical team to carefully discuss the surgical plan and make careful and careful preparations for each preoperative preparation. The doctor successfully performed bilateral thyroidectomy on him and also cleared the lymph nodes of the bilateral neck. A total of 36 lymph nodes were cleared, including 5 metastasized lymph nodes. Yu Jiangtao, attending physician in the first ward of general waitress, said: "The patient's radical lateral cervical lymph node dissection is mainly to extend the patient's survival time, to completely cure the patient, and avoid recurrence and secondary surgery." After
, Ms. Li recovered quickly. Not only did she speak and pronounce her pronunciation normally, but she also tested parathyroid hormone. There were no complications of lymphatic leakage, and she was discharged from the hospital soon.
It is reported that thyroidectomy and standardized cervical lymph node dissection are currently recognized as the first choice for the treatment of differentiated thyroid cancer.
The physician team of general wait area 1 (hernia and abdominal wall, thyroid surgery) in Zhengzhou People's Hospital is one of the few teams in the province that can carry out this surgery, which shows that our hospital's thyroid diagnosis and treatment technology has reached a new level.
Why do you get thyroid cancer?
So far, the cause of thyroid cancer is not fully understood. But it may be related to the following reasons:
1.History of radiation exposure to head and neck or contact with radioactive dust in childhood;
2.Overdue iodine intake;
3.has a history of systemic radiation therapy;
4.has a past or family history of thyroid cancer;
5.women;
6.Age ＜14 years old or >70 years old. What should I do if
is found in thyroid cancer?
Currently, there are the following treatment plans for the treatment of thyroid cancer:
1. surgical treatment;
2.TSH inhibitory treatment treatment;
3. isotope iodine 131 treatment;
4. targeted drug treatment, radiotherapy, etc.
What are the types of surgery for thyroid cancer?
thyroid surgery is mainly divided into two categories:
1.Total or near-total thyroidectomy, with or without lymph node dissection;
2.thyroid lobe resection, with or without lymph node dissection. What should I do if TI-RADs 3 and TI-RADs 4 are abnormal in
physical examination report?
TI-RADs is the abbreviation of thyroid imaging reporting and data system. It was first proposed by Horvath in 2009. It divides its malignancy into 1-6 categories based on the unique ultrasound manifestations of thyroid nodules. Among them, TI-RADs class 3 indicates that there is a possible benign nodule, and its malignancy probability is less than 5%.
TI-RADs 4 categories represent suspicious malignant nodules, which can be divided into 4A, 4B and 4C. The probability of malignancy is 5%-10%, 10%-50% and 50%-94% respectively. If the examination report suggests TI-RADs 3 type thyroid nodules, regular ultrasound examinations can be used for clinical follow-up. If the examination report prompts TI-RADs type 4 thyroid nodules, it is recommended to perform ultrasound-guided fine needle aspiration (FNAB) and enhanced CT to further evaluate the condition, and decide the treatment plan based on the examination results.
Why does thyroid cancer surgery pay attention to lymph node dissection?
Neck lymph node metastasis is the most common metastasis method for thyroid cancer, and neck lymph node metastasis is also the most common recurrence site after thyroid cancer surgery. It is reported that 20%-50% of patients with papillary thyroid carcinoma have cervical lymph node metastasis before initial treatment.
surgery is the preferred treatment for neck lymph node metastasis in thyroid cancer. According to domestic and foreign guidelines, preventive central zone lymph node dissection is generally performed while treating primary tumors. When preoperative color ultrasound is highly suspected or puncture confirms lymph node metastasis in the cervical lateral zone, standardized cervical lateral zone lymph node dissection must be performed. The thoroughness of cervical lymph node dissection is very important for improving the prognosis of patients with thyroid. What are the functions of cervical lymph node dissection in
standardized in the treatment of thyroid cancer?
The standardization of cervical lymph node dissection is directly related to the efficacy. Cervical lymph node dissection has high technical requirements for the surgeon. Not only should you have good skills, but more importantly, you should be familiar with the local anatomy. Only when the two are organically combined can standardized and proficient cervical lymph node dissection be carried out, which can improve the efficacy while minimizing surgical complications.
However, clinically irregular lymph node dissection in the cervical lateral area is not uncommon, mainly manifested as inadequate dissection.
cervical lateral area lymph node dissection is to deal with the medial cervical sheath, vagus nerve, phrenic nerve, lateral paranormal nerve, brachial plexus nerve and its lower transverse cervical blood vessels and lymphatic vessels, as well as several important areas that are easily missed (intermuscular lymph nodes, parapharyngeal lymph nodes, posterior lymph nodes of the paranormal nerve, etc.).
For lymph node dissection in the cervical lateral area of thyroid cancer, functional tissue should be retained as much as possible on the basis of ensuring the thoroughness of the dissection, which should not only ensure the efficacy, but also improve the quality of life of the patient after surgery.
is very important to accurately evaluate the lymph node status of the cervical lateral area of thyroid cancer patients, and it directly determines the choice of the patient's treatment plan and the evaluation of the prognosis. Before the operation, the location, size, number, location of the cervical lymph nodes and whether there are signs of extracapsular invasion of the lymph nodes should be obtained through imaging examinations such as neck palpation and neck ultrasound, CT, and nuclear magnetic resonance (MR).
Do you still need to take long-term medication after thyroid cancer?
Due to surgery, most or all of the thyroidectomy is reduced, and thyroxine secretion is generally required for lifelong thyroxine replacement or inhibition treatment: TSH in high-risk patients must be inhibited below 0.1; TSH in medium-risk patients must be inhibited between 0.1 and 0.5; TSH in low-risk patients must be inhibited between 0.5 and 2.
How often does it take to check after surgery for patients with thyroid cancer?
Be sure to pay attention to follow-up, regularly monitor thyroid hormone and TSH levels, check once every 1 month during the dose adjustment period, and check once every 3 to 6 months in the future to avoid side effects caused by overdose or insufficient drugs and affect the treatment effect.
Regular ultrasound examination of thyroid and neck lymph nodes.
Expert Profile
Sun Deli
未分类新开未分类未分类未分类未分类未分类未分类未分类未分类� Chief physician
★ Member of the Thyroid Surgery Branch of Henan Medical Association
★ Chinese Medical Association National Committee of the Hernia and Abdominal Wall Surgery Association
★ Member of the Henan General Surgery Association
★ Member of the Henan Provincial Hernia and Abdominal Wall Surgery Association
★ Member of the Henan Provincial Hernia and Abdominal Wall Surgery Association
Specializes in the diagnosis and treatment of abdominal wall hernia , thyroid disease , acute abdominal disease , liver and spleen rupture, gastrointestinal perforation, acute pancreatitis, and intestinal obstruction. Among them, it is the leading province in the treatment of abdominal wall hernia surgery, and is the first to carry out hernia tension-free repair (modified Kugel) and light reticulum inguinal hernia repair in Henan Province, greatly reducing the recurrence rate after hernia. Currently, the number of successfully completed improved Kugel hernia repairs ranks first in Henan Province and ranks among the top in China.
has published more than 20 papers in series of Chinese Medical Association magazines and related journals.
Jiehanbing
Deputy Director of General Waste 1, Deputy Chief Physician
★ Standing Committee Member of the Retroperitoneal Oncology Committee of Henan Anti-Cancer Association
Master of Medicine, graduated from Zhengzhou University, specializes in the diagnosis and treatment of surgical acute abdominal diseases, abdominal wall hernia, and thyroid diseases, especially in the minimally invasive treatment of thyroid tumors and abdominal wall hernia. He has published more than 20 papers, 10 core papers, and a monograph.
Yu Jiangtao
Attendant physician in the first ward of general foreign affairs. Master of medicine
★ Member of the Head and Neck Professional Committee of the Chinese Medical Education Association
graduated from Zhengzhou University. He is good at the diagnosis and treatment of common and frequently occurring diseases in general surgery. He has published more than 10 papers and has studied in the head and neck surgery department of the Cancer Hospital of the Chinese Academy of Medical Sciences. He studied under Professors Tang Pingzhang, Professor Li Zhengjiang, and Professor An Changming to learn standardized treatment of thyroid cancer, especially the radical dissection of cervical lymph nodes. Proficient in ultrasound-guided fine needle aspiration technology (FNAB) of thyroid nodules, standardized treatment of thyroid cancer, and lymph node dissection technology in the cervical lateral area.
Department consultation phone number: 0371-67077008
(Yu Hua, Zhengzhou People's Hospital / Text)
