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《2015美国甲状腺学会成人甲状腺结节与分化型甲状腺癌诊治指南》外科治疗更新解读

An introduction of surgical update in 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer

摘要:

甲状腺结节和甲状腺癌的发病率近年来均呈上升趋势,引起了人们广泛的关注.外科手术是治疗甲状腺结节和分化型甲状腺癌的重要方法,规范化的手术方式能让甲状腺癌患者获得极好的生存率和预后,而不规范的手术方式会增加病灶复发的风险,增加二次手术率,降低生存率,从生理、心理和经济上给患者和家属带来巨大负担.目前国内外为了规范甲状腺结节和甲状腺癌的治疗颁布了很多指南,其中最为著名的是美国甲状腺学会颁布的《甲状腺结节和分化型甲状腺癌诊治指南》(2006年)及其修订版(2009年).2015年美国甲状腺学会再次组织甲状腺领域的专家更新了指南,其中外科治疗部分基于新的循证医学证据也有所更改,包括甲状腺结节的手术方式及指征、妊娠期甲状腺癌的手术处理、分化型甲状腺癌初次手术及补充手术的处理原则、淋巴结清扫、喉返神经和甲状旁腺的处理、复发和侵犯呼吸消化道甲状腺癌的手术处理等.

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abstracts:

Both of the incidences of thyroid nodules and thyroid cancer have increased in recent years,which have attracted extensive attention.Surgical treatment plays an important role on the management of thyroid nodules and differentiated thyroid cancer (DTC).Usually patients will have an excellent prognosis after standard surgery,in the meantime,they will suffer from wrongly performed operation,which induces bad outcomes for the patients and their families both physically and psychologically,as well as economic burden.There are many guidelines concerning the suitable treatment for thyroid nodules and thyroid cancer all over the world,and the most famous one is American Thyroid Association (ATA) Management Guidelines for Patients with Thyroid Nodules and DTC in 1996 and the revised version in 2009.Over the past several years,there have been many advances in both the diagnosis and treatment of thyroid nodules and DTC.As a result,the ATA had updated the guidelines in 2015.In this article,we introduced the surgical update in 2015 ATA management guidelines for adult patients with thyroid nodules and DTC compared to the 2009 version,which consists of appropriate operation for thyroid nodules and DTC,operation for pregnant women with DTC,lymph node dissection,completion thyroidectomy,appropriate perioperative approach to voice and parathyroid,and surgery for advanced cancer.

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作者: 兰霞斌 [1] 张浩 [1]
第一作者: 兰霞斌
期刊: 《中华外科杂志》2016年54卷3期 172-176页 MEDLINEISTICPKUCSCD
栏目名称: 指南解读
DOI: 10.3760/cma.j.issn.0529-5815.2016.03.004
发布时间: 2016-03-31
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