Surgical Treatment Of Differentiated Thyroid

The thyroid cancer is a common malignant tumor in head and neck, which draws attention from many scholars at home and abroad. According to the differences of tumor cells under the microscope, the thyroid cancer can be divided into different types of pathology, namely, papillary cancer, follicular cancer, medullary cancer, undifferentiated cancer. The papillary cancel and follicular cancer are the most common types, taking 90% of all thyroid cancers, the two of them are collectively referred to as differentiated thyroid cancer (DTC). Most of thyroid cancers are relatively low malignancy tumor, especially DTC, which can be treated well through early diagnosis and timely operation treatment, because of its well differentiated.At present, modern medicine in the treatment of DTC mainly relies on surgical operation. Operation scheme not only affect the short-term effect in the treatment of patients with DTC, but also relates to whether the patients have a good prognosis. To establish a relatively reasonable operation scheme, the domestic and foreign scholars have been carrying out relevant researches, which deepens knowledge of the disease, produces new ideas adopted. Coupled with the new medical equipment and technology continuously emerging, the operation treatment of DTC has made significant progress. Taking results of clinical researches and scholars’ experiences into account, many countries have issued guidelines, which put forward a lot of suggestions for possible operation in the treatment of DTC. However, since the guidelines did not fully unified guidance, in the actual process of diagnosis and treatment, clinicians still have some differences in the choices of some specific issues.This paper, referring to more than 90 articles related to the guidelines on the DTC for the diagnosis and treatment at home and abroad and clinical studies reported, puts forward some problems related to the operation of DTC treatment, and reviews the opinions and suggestions in dealing with the specific problems of domestic and foreign scholars. The consensus and controversies of DTC operation treatment were described in details, the similarities and differences were summarized, and the advantages and disadvantages of them were compared, which would play a certain reference role in clinical work.The present situation of DTC operation therapy is as follows:concerning diagnosis before operation, the current high specificity accepted examination includes thyroid stimulating hormone (TSH), B ultrasound, radionuclide imaging and fine needle aspiration biopsy (FNAB). Scholars in Europe and USA emphasize the necessity of B ultrasound much more than the domestic, and propose FNAB as a routine examination before operation on thyroid nodules. Although the domestic also recognize the value of FNAB, intraoperative frozen pathological examination to confirm the diagnosis is a much more common choice. Regarding the choice of anesthesia in the operation, it is recognized that general anesthesia effect was the best, while some scholars believe that the use of local anesthesia as auxiliary can achieve better results at the same time of general anesthesia. In the aspect of the operation method selection, traditional open operation, with adaption to a wide range of operation and strong controllability predominates. Because of the significant cosmetic result, endoscopic thyroid operation becomes more and more popular among patients and surgeons. The emerging robot operation Da Vinci, with the advantage of traditional operation and laparoscopic operation, is hard to get popular, because of expensive price. In the scope of the above operation excision, some scholars believe that total or near total thyroidectomy is the mainstream method, while some choose to do small range of surgical resection, balancing the operation risk, patient factors and prognosis. In the treatment of cervical lymph nodes, the agreement that the patients with the lymph node metastasis or suspected transfer should be treated by sweeping has been reached, while preventive dissection is still controversial for patients without the evidence of cervical lymph node metastasis. The most serious complication of DTC operation is the injury of parathyroid and laryngeal recurrent nerve during the operation, which can be prevented by conventional anatomical exposure of recurrent laryngeal nerve and parathyroid practices.Traditional Chinese medicine (TCM) also have a deeper understanding of thyroid cancer, which belongs to the stony goiter. Although the main treatment for DTC currently relies on surgical operation, TCM also plays an important role in alleviating postoperative quality of life, reducing the postoperative recurrence rate, and improving the postoperative. The author believes that, in the operation of DTC, a comprehensive assessment needs to be done in the patient’s condition, the difficulty and risk of operation, hospital conditions, the surgeon’s experience, costs, the prognosis of patients, and based on which, an optimal operation program can be developed.