目的 总结分化型甲状腺癌的治疗经验。方法 2010年9月-2012年3月，医院收治30例分化性甲状腺癌。开放状态下 甲状腺患侧腺叶全切＋峡部切除10例，患侧甲状腺叶加对侧叶次全切除9例，甲状腺腺近全切除术或甲状腺全切除 术10例，甲状腺姑息手术1例，功能性淋巴结清扫15例，选择性颈部淋巴结清横扫1例、经典颈部淋巴结清扫1例。 术后1个月进行131I 放射治疗联合维甲酸，在放疗1周左右进行促甲状腺激素抑制治疗。结果 放射治疗，出现1例不 良反应。出现2例暂时性低钙血症，1年、3年、5年存活率为100.0%，甲状腺患侧腺叶＋峡部切除出现5例颈部淋巴 结转移，分别发生时间10个月、14个月、20个月、21个月和27个月，未见其他转移复发情况。T3、T4、TSH、FT4、 FT3与术前差异有统计学意义(P＜0.05)，指标达到控制标准。首次清甲成功率76.7%(23/30)。未见永久性低钙血 症，术后生活质量评分略低于正常水平，高于术前(P＜0.05)。结论 手术+颈部淋巴结清扫+放射性碘131I 治疗+甲 状腺素+维甲酸可有效治疗分化型甲状腺癌，减少患者术后转移，提高术后存活率；手术方式和淋巴结清扫根据腺 体部位、大小、TNM分期、合并甲状腺临床表现来定。

Objective To summarize the experience in the treatment of differentiated thyroid carcinoma. Methods From September 2010 to March-2012, 30 patients with differentiated thyroid carcinoma were treated in our hospital. The open state of thyroid unilateral thyroidectomy and isthmus resection in 10 cases, ipsilateral thyroid lobe and leaf subtotal resection in 9 cases, thyroid gland near total resection or total thyroidectomy in 10 cases, 1 cases of thyroid function of palliative surgery, 15 cases of lymph node dissection of cervical lymph nodes, 1 cases of selective sweep of Qing Dynasty cervical lymph node dissection, 1 cases of classic. 131I radiotherapy combined with retinoic acid was performed 1 months after operation, and thyroid stimulating hormone therapy was performed at about 1 weeks after radiotherapy. Results There were 1 cases of adverse reactions after radiotherapy. 2 cases of temporary hypocalcemia, 1 years, 3 years, 5 years survival rate was 100.0%, ipsilateral thyroid lobe plus isthmic resection 5 cases of cervical lymph node metastasis, respectively the occurrence time of 10 months, 14 months, 20 months, 21 months and 27 months, no recurrence of metastasis. T3, T4, TSH, FT4, FT3 and preoperative difference was statistically significant (P<0.05), the indicators reached the control standard. The success rate of first nail cleaning was 76.7% (23/30). No permanent hypocalcemia, quality of life score is slightly lower than the normal level after operation than before operation (P <0.05). Conclusion The surgical treatment of cervical lymph node of 131I + + + + thyroxine retinoic acid cleaning is effective in the treatment of differentiated thyroid cancer, reduce postoperative metastasis, improve the survival rate after surgery; surgery and lymph node dissection according to gland size and location, TNM staging, combined with clinical manifestations to the thyroid gland.