xov xwm

Kwv yees li ntawm 1.2% ntawm cov tib neeg yuav raug kuaj mob qog noj ntshav hauv lawv lub neej. Hauv 40 xyoo dhau los, vim kev siv cov duab dav dav thiab kev qhia txog cov koob txhaj tshuaj zoo, qhov kev kuaj pom ntawm cov qog nqaij hlav qog nqaij hlav tau nce ntau, thiab qhov tshwm sim ntawm cov qog nqaij hlav qog nqaij hlav tau nce peb npaug. Kev kho mob qog nqaij hlav qog noj ntshav tau nce sai hauv 5 txog 10 xyoo dhau los, nrog ntau yam kev cai tshiab tau txais kev pom zoo los ntawm kev tswj hwm.

Kev raug ionizing hluav taws xob thaum menyuam yaus feem ntau cuam tshuam nrog papillary thyroid cancer (1.3 txog 35.1 tus neeg mob / 10,000 tus neeg-xyoo). Ib txoj kev tshawb fawb uas tau soj ntsuam 13,127 cov menyuam yaus hnub nyoog qis dua 18 xyoo nyob hauv Ukraine tom qab xyoo 1986 Chernobyl nuclear kev sib tsoo rau cov qog nqaij hlav qog nqaij hlav pom muaj tag nrho ntawm 45 tus neeg mob qog noj ntshav uas muaj kev pheej hmoo ntau dhau ntawm 5.25 / Gy rau cov thyroid cancer. Kuj tseem muaj kev sib raug zoo ntawm koob tshuaj ntawm ionizing hluav taws xob thiab thyroid cancer. Lub hnub nyoog qis dua uas tau txais hluav taws xob ionizing, qhov kev pheej hmoo ntawm kev tsim hluav taws xob ntsig txog cov thyroid cancer, thiab qhov kev pheej hmoo no tseem muaj ze li 30 xyoo tom qab raug.

Feem ntau cov kev pheej hmoo rau cov qog nqaij hlav qog nqaij hlav yog hloov tsis tau: hnub nyoog, poj niam txiv neej, haiv neeg lossis haiv neeg, thiab tsev neeg keeb kwm ntawm cov qog nqaij hlav qog noj ntshav yog qhov tseem ceeb tshaj plaws ntawm kev pheej hmoo. Lub hnub nyoog laus dua, qhov tshwm sim ntau dua thiab qis dua qhov ciaj sia taus. Cov qog nqaij hlav qog noj ntshav yog peb zaug ntau dua rau cov poj niam dua li cov txiv neej, tus nqi uas nyob ib puag ncig thoob ntiaj teb. Genetic variation nyob rau hauv kab kab mob ntawm 25% ntawm cov neeg mob uas muaj medullary thyroid carcinoma yog txuam nrog ntau yam endocrine qog syndromes hom 2A thiab 2B. 3% mus rau 9% ntawm cov neeg mob uas muaj qhov sib txawv ntawm cov thyroid mob cancer muaj keeb kwm yav dhau los.

Kev soj ntsuam ntawm ntau dua 8 lab tus neeg nyob hauv Denmark tau pom tias tsis muaj tshuaj lom nodular goiter cuam tshuam nrog kev pheej hmoo ntawm cov thyroid cancer. Hauv kev tshawb nrhiav rov qab los ntawm 843 cov neeg mob uas tau kho cov thyroid phais rau unilateral lossis ob tog thyroid nodule, goiter, lossis autoimmune thyroid kab mob, ntau dua preoperative serum thyrotropin (TSH) qib tau txuam nrog thyroid cancer: 16% ntawm cov neeg mob TSH qib qis dua 0.06 mIU / L tsim cov thyroid cancer, thaum 52% ntawm cov neeg mob qog noj ntshav.

Cov neeg mob qog nqaij hlav thyroid feem ntau tsis muaj tsos mob. Kev tshawb nrhiav rov qab ntawm 1328 cov neeg mob qog nqaij hlav qog noj ntshav ntawm 16 lub chaw hauv 4 lub tebchaws tau pom tias tsuas yog 30% (183/613) muaj cov tsos mob ntawm kev kuaj mob. Cov neeg mob uas muaj caj dab loj, dysphagia, txawv teb chaws lub cev hnov ​​​​lus thiab hoarseness feem ntau mob hnyav dua.

Cov qog nqaij hlav qog noj ntshav ib txwm muaj raws li cov thyroid nodule palpable. Qhov tshwm sim ntawm cov qog nqaij hlav qog nqaij hlav hauv palpable nodules tau tshaj tawm tias muaj li ntawm 5% thiab 1%, feem, hauv cov poj niam thiab cov txiv neej hauv thaj chaw iodine txaus hauv ntiaj teb. Tam sim no, kwv yees li 30% mus rau 40% ntawm cov qog nqaij hlav thyroid pom los ntawm palpation. Lwm yam kev kuaj mob muaj xws li cov duab tsis yog cov thyroid (xws li, carotid ultrasound, caj dab, txha nraub qaum, thiab hauv siab duab); Cov neeg mob hyperthyroidism lossis hypothyroidism uas tsis tau kov cov nodules tau txais thyroid ultrasound; Cov neeg mob uas muaj cov thyroid nodules tau rov ua dua nrog ultrasound; Ib qho kev xav pom tsis pom ntawm occult thyroid cancer tau ua thaum lub sij hawm tom qab kev kuaj mob pathologic.

Ultrasound yog txoj kev nyiam ntawm kev ntsuam xyuas rau palpable thyroid nodules lossis lwm yam kev kuaj pom ntawm cov thyroid nodules. Ultrasound yog qhov tseem ceeb heev hauv kev txiav txim siab tus naj npawb thiab cov yam ntxwv ntawm cov thyroid nodules nrog rau cov yam ntxwv muaj feem cuam tshuam nrog kev pheej hmoo ntawm malignancy, xws li marginal irregularities, punctate muaj zog echoic tsom, thiab ntxiv-thyroid ntxeem tau.

Tam sim no, overdiagnosis thiab kho cov thyroid cancer yog ib qho teeb meem uas ntau tus kws kho mob thiab cov neeg mob them tshwj xeeb rau, thiab cov kws kho mob yuav tsum sim kom tsis txhob overdiagnosis. Tab sis qhov nyiaj tshuav no yog qhov nyuaj rau kev ua tiav vim tias tsis yog txhua tus neeg mob uas muaj mob qog noj ntshav, metastatic thyroid cancer tuaj yeem hnov ​​​​cov thyroid nodules, thiab tsis yog txhua qhov kev kuaj mob qog nqaij hlav qog nqaij hlav uas muaj feem yuav raug zam. Piv txwv li, qee zaus cov thyroid microcarcinoma uas yuav tsis ua rau cov tsos mob lossis kev tuag tuaj yeem kuaj mob histologically tom qab phais rau cov kab mob benign thyroid.

Kev kho mob tsawg kawg nkaus xws li ultrasound-guided radiofrequency ablation, microwave ablation thiab laser ablation muab ib qho kev cog lus rau kev phais thaum uas tsis tshua muaj thyroid cancer yuav tsum tau kho. Txawm hais tias cov txheej txheem ntawm kev ua ntawm peb txoj kev ablation txawv me ntsis, lawv yeej zoo ib yam ntawm cov qauv xaiv qog, qog cov lus teb, thiab cov teeb meem tom qab phais. Tam sim no, cov kws kho mob feem ntau pom zoo tias qhov zoo tshaj plaws qog nqaij hlav rau kev cuam tshuam tsawg kawg yog ib qho kab mob hauv cov thyroid papillary carcinoma < 10 mm inch thiab> 5 mm los ntawm cov txheej txheem kub-rhiab xws li trachea, esophagus, thiab laryngeal paj hlwb. Cov teeb meem tshwm sim feem ntau tom qab kev kho mob tseem tsis tuaj yeem raug mob thaum kub hnyiab rau cov hlab ntsha ntawm cov hlab ntsha nyob ze, ua rau hoarseness ib ntus. Yuav kom txo qis kev puas tsuaj rau cov vaj tse nyob ib puag ncig, nws raug nquahu kom tawm qhov kev nyab xeeb deb ntawm lub hom phiaj lesion.

Ntau cov kev tshawb fawb tau pom tias kev cuam tshuam tsawg kawg nkaus hauv kev kho cov thyroid papillary microcarcinoma muaj txiaj ntsig zoo thiab kev nyab xeeb. Txawm hais tias qhov kev cuam tshuam tsawg kawg nkaus rau cov qog nqaij hlav qog nqaij hlav qog nqaij hlav uas tsis tshua muaj txiaj ntsig tau txais txiaj ntsig zoo, feem ntau cov kev tshawb fawb tau rov qab los thiab tsom mus rau Tuam Tshoj, Ltalis, thiab Kaus Lim Qab Teb. Tsis tas li ntawd, tsis muaj kev sib piv ncaj qha ntawm kev siv cov kev cuam tshuam me me thiab kev soj ntsuam nquag. Yog li ntawd, ultrasound-guided thermal ablation tsuas yog tsim nyog rau cov neeg mob uas tsis tshua muaj mob qog nqaij hlav qog noj ntshav uas tsis yog cov neeg sib tw rau kev kho mob phais lossis leej twg nyiam txoj kev kho mob no.

Nyob rau hauv lub neej yav tom ntej, rau cov neeg mob uas muaj kev kho mob tseem ceeb thyroid cancer, minimally invasive interventional therapy tej zaum yuav yog lwm txoj kev kho mob uas muaj kev pheej hmoo ntawm cov teeb meem tsawg tshaj li kev phais. Txij li xyoo 2021, cov txheej txheem thermal ablation tau siv los kho cov neeg mob qog nqaij hlav qog nqaij hlav hauv qab 38 hli (T1b ~ T2) nrog cov yam ntxwv muaj kev pheej hmoo siab. Txawm li cas los xij, cov kev tshawb fawb rov qab no suav nrog cov neeg mob me me (xws li ntawm 12 txog 172) thiab lub sijhawm luv luv (txhais tau tias 19.8 txog 25.0 lub hlis). Yog li ntawd, kev tshawb fawb ntxiv yog xav tau kom nkag siab txog tus nqi ntawm thermal ablation hauv kev kho mob ntawm cov neeg mob uas muaj cov thyroid cancer tseem ceeb.

Kev phais tseem yog thawj txoj hauv kev ntawm kev kho mob rau qhov xav tias lossis cytologically paub tseeb tias txawv thyroid carcinoma. Muaj kev sib cav txog qhov tsim nyog tshaj plaws ntawm cov thyroidectomy (lobectomy thiab tag nrho cov thyroidectomy). Cov neeg mob uas tau txais tag nrho cov thyroidectomy yog qhov kev pheej hmoo ntawm kev phais ntau dua li cov neeg mob lobectomy. Kev pheej hmoo ntawm kev phais cov thyroid muaj xws li rov ua rau cov hlab ntsha puas tsuaj, hypoparathyroidism, mob qhov txhab, thiab xav tau cov thyroid hormone supplementation. Yav dhau los, tag nrho cov thyroidectomy yog qhov kev kho mob zoo tshaj plaws rau txhua qhov sib txawv ntawm cov qog nqaij hlav qog> 10 hli. Txawm li cas los xij, kev tshawb fawb xyoo 2014 los ntawm Adas thiab al. pom tias tsis muaj qhov sib txawv tseem ceeb hauv kev muaj sia nyob thiab kev pheej hmoo rov qab los ntawm cov neeg mob uas tau txais lobectomy thiab tag nrho cov thyroidectomy rau 10 hli mus rau 40 hli papillary thyroid cancer yam tsis muaj kev pheej hmoo siab.

Yog li, tam sim no, lobectomy feem ntau nyiam rau unilateral zoo-differentiated thyroid cancer <40 mm. Tag nrho cov thyroidectomy feem ntau pom zoo rau qhov sib txawv ntawm cov thyroid cancer ntawm 40 mm los yog loj dua thiab ob sab thyroid cancer. Yog tias cov qog tau kis mus rau cov qog ntshav hauv cheeb tsam, yuav tsum tau ua qhov kev txiav tawm ntawm lub hauv nruab nrab thiab cov qog ntshav ntawm lub caj dab. Tsuas yog cov neeg mob uas muaj medullary thyroid cancer thiab qee qhov sib txawv loj-ntim cov qog nqaij hlav qog nqaij hlav, nrog rau cov neeg mob uas muaj cov thyroid sab nraud, xav tau kev kho mob hauv nruab nrab cov qog ntshav qog ntshav. Prophylactic lateral cervical lymph node dissection tej zaum yuav raug txiav txim siab rau cov neeg mob uas muaj medullary thyroid cancer. Hauv cov neeg mob uas xav tias muaj kab mob qog nqaij hlav qog nqaij hlav hauv cov thyroid caj pas, plasma qib ntawm norepinephrine, calcium, thiab parathyroid hormone (PTH) yuav tsum raug soj ntsuam ua ntej kev phais kom txheeb xyuas MEN2A syndrome thiab tsis txhob ploj pheochromocytoma thiab hyperparathyroidism.

Nerve intubation feem ntau yog siv los txuas nrog lub paj hlwb uas tsim nyog los muab txoj hauv kev uas tsis muaj kev cuam tshuam thiab saib xyuas cov leeg nqaij thiab paj hlwb hauv lub larynx.

EMG Endotracheal Tube Khoom nyem ntawm no