Male and female had the same risk to get PTC. The onset age was somewhat younger than that of PHPT. Most patients were bone-renal mixture type with severe symptoms. Serum calcernia were more than 3.5mmol/L. with high PTH level. Diagnosis of PTC mainly depended on operative findings. PTC was lobulated, hard mass,surrounded by a dense fibrous grayish-white capsule that adhered tenaciously to adjacent tissues. Frozen section was of little value in distinguishing malignant from benign disease. The histopathological features were not high specific.
All four glands should be explored during operation. When gross pathological findings suggested malignancy,lesion should be removed completely with ipsilateral thyroid-isthnus and any contiguous tissues adhered. Radical lymph node excision was also performed. Serum calcium and PTH level were monitored every three months. Recurrent carcinoma in neck was treated with wide excision of involved area. And accessible distant metastases were resected when possible. PTC was not a radiosensitive tumor. Chemotherapy had uncertain effect. PTC tended to recur locally, spread in neck, metastases via lymphatic and hematogenous routes.
PTC was the tumor with relative low malignant potential. Diagnosis depended on intra-operative gross pathological findings. Frozen examination had little value. Early recognition and complete resection at initial operation carried the best prognosis. For recurrence or metastatic cases, surgical procedure was the primarily management. For very late cases, well control of hypercalcemia could prolong survival time.
參考譯文
PTC 患者男女比例相當(dāng),平均發(fā)病年齡較PHPT輕,大多數(shù)患者為骨腎混合型,且癥狀較嚴(yán)重,不少患者可捫及頸部腫塊?；颊叩难}可高達3.5mmol/L以上,PTH 也明顯增高。PTC 的診斷很大程度上依賴術(shù)中大體標(biāo)本的判斷,它呈分葉狀,質(zhì)地堅硬,大多有灰白色致密纖維樣物與周圍組織緊密粘連,很難分離。術(shù)中冷凍對鑒別甲狀旁腺腫瘤的良惡性意義不大,鏡下病理學(xué)檢查的特異性不強。
手術(shù)要全面探查4個旁腺,切除腫瘤、患側(cè)甲狀腺葉至峽部及所有與腫瘤粘連的組織,徹底清掃頸部淋巴結(jié)。術(shù)后每3個月復(fù)查1次血鈣及PTH。頸部復(fù)發(fā)的再次手術(shù)需廣泛切除受累區(qū)域,遠(yuǎn)處轉(zhuǎn)移要盡可能切除。PTC對放療、化療不敏感。它可局部復(fù)發(fā)、頸部播散,并通過淋巴和血運途徑轉(zhuǎn)移。
PTC是一種相對低度惡性的腫瘤。診斷是依靠術(shù)中大體標(biāo)本得到的判斷，冷凍價值不大。首次手術(shù)時的早期認(rèn)識和徹底根治是影響預(yù)后最重要的影響因素。對復(fù)發(fā)或轉(zhuǎn)移仍應(yīng)積極手術(shù),病程晚期也要盡力控制高血鈣以延長生存期。
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