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Inenge 1.2% yevanhu vanozoonekwa vaine kenza yethyroid munguva yehupenyu hwavo. Mumakore makumi mana adarika, nemhaka yekushandiswa kwakapararira kwemifananidzo uye kutangwa kwegomba retsono rakanaka, mwero wokuonekwa kwegomarara rethyroid wakawedzera zvakanyanya, uye chiitiko chegomarara rethyroid chakawedzera katatu. Kurapwa kwegomarara rethyroid kwakafambira mberi nekukurumidza mumakore mashanu kusvika gumi apfuura, paine akasiyana maprotocol matsva anowana mvumo yekutonga.

Kuratidzwa kweiyo ionizing radiation panguva yehudiki kwainyanya kubatanidzwa nepapillary thyroid cancer (1.3 kusvika 35.1 kesi / 10,000 munhu-makore). Chidzidzo checohort chakaongorora vana 13,127 vari pasi pemakore gumi nemasere vanogara muUkraine mushure menjodzi yenyukireya yeChernobyl ye1986 yegomarara rethyroid yakawana huwandu hwemakumi mana neshanu ekenza yegomarara ine ngozi yakawandisa ye5.25 / Gy yegomarara regomarara. Kune zvakare hukama-hwemhinduro pakati peiyo ionizing radiation negomarara regomarara. Pazera rediki iro mwaranzi yeionizing yakagamuchirwa, ndipo pakawedzera njodzi yekubatwa negomarara rethyroid rine chekuita nemwaranzi, uye njodzi iyi yakaramba iripo makore anoda kusvika makumi matatu mushure mekuratidzwa.

Zvizhinji zvengozi dzegomarara rethyroid hazvichinjiki: zera, bonde, rudzi kana dzinza, uye nhoroondo yemhuri yegomarara rethyroid ndiyo inonyanya kukosha yekufungidzira. Kukura kwezera, kunowedzera chiitiko uye kuderera kwehuwandu hwekupona. Gomarara rethyroid rakawanda zvakapetwa katatu muvakadzi kupfuura varume, mwero unoramba uripo pasi rose. Kusiyana kweGerm mumutsara we25% yevarwere vane medullary thyroid carcinoma inobatanidza nekugara nhaka yakawanda endocrine tumor syndromes rudzi 2A uye 2B. 3% kusvika 9% yevarwere vane yakanyatsosiyana-siyana kenza yegomarara vane nhaka.

Kutevera kwevanopfuura mamirioni masere vagari muDenmark kwakaratidza kuti non-chepfu nodular goiter inobatanidza nenjodzi yakawedzera yegomarara rethyroid. Muchidzidzo chekuongorora chevarwere ve843 vari kuvhiyiwa thyroid kune unilateral kana bilateral thyroid nodule, goiter, kana autoimmune thyroid chirwere, yakakwirira preoperative serum thyrotropin (TSH) mazinga akabatanidzwa nekenza yekenza: 16% yevarwere vane TSH mazinga ari pasi pe0.06 mIU / L vakagadzira kenza yekenza yekenza, asi TSH 52% yekenza yakagadziriswa.

Vanhu vane gomarara rethyroid kazhinji havana zviratidzo. Ongororo yakadzokororwa yevarwere ve1328 vane kenza yekenza pa16 nzvimbo munyika dze4 yakaratidza kuti 30% chete (183/613) yaiva nezviratidzo pakuongororwa. Varwere vane mitsipa yakawanda, dysphagia, kunzwa kwekunze kwemuviri wekunze uye hoarseness vanowanzorwara zvakanyanya.

Chirwere chegomarara regomarara rinogara richiratidza senge twunduru. Chiitiko chegomarara rethyroid mumapundu anonzwika anonzi angangoita 5% uye 1%, zvichiteerana, muvakadzi nevarume munzvimbo dzakakwana dzeiodine pasi rose. Parizvino, inenge 30% kusvika 40% yegomarara rethyroid rinowanikwa kuburikidza ne palpation. Dzimwe nzira dzakajairika dzekuongorora dzinosanganisira mifananidzo isiri yethyroid ine chekuita (semuenzaniso, carotid ultrasound, mutsipa, musana, uye chipfuva imaging); Varwere vane hyperthyroidism kana hypothyroidism vasina kubata mazamu vanogamuchira thyroid ultrasonography; Varwere vane utachiona huripo mazamu akadzokororwa ne ultrasound; Kuwanikwa kusingatarisirwi kwegomarara rehuroyi kwakaitwa panguva yekuongororwa kwepathologic mushure mekushanda.

Ultrasound ndiyo nzira inosarudzika yekuongorora mazamu anonzwika ethyroid kana zvimwe zvakawanikwa zvekufungidzira zvethyroid nodules. Ultrasound inonyanya kunzwisiswa pakusarudza nhamba uye maitiro ehutano hwetroroid nodules pamwe chete nepamusoro-soro zvinhu zvinosangana nenjodzi yehutachiona, zvakadai sekukanganiswa kwemarginal, punctate yakasimba echoic focus, uye extra-thyroid invasion.

Parizvino, overdiagnosis uye kurapwa kwegomarara rethyroid idambudziko iro vanachiremba vazhinji nevarwere vanotarisisa zvakanyanya, uye varapi vanofanirwa kuyedza kudzivirira overdiagnosis. Asi chiyero ichi chakaoma kuwana nekuti havazi vese varwere vane advanced, metastatic thyroid cancer vanogona kunzwa thyroid nodules, uye havasi vese vane njodzi yakaderera kenza yegomarara inodzivirirwa. Semuenzaniso, imwe nguva thyroid microcarcinoma iyo inogona kusambokonzera zviratidzo kana kufa inogona kuongororwa histologically mushure mekuvhiyiwa kwebenign thyroid chirwere.

Mishonga inopindira yekurapa senge ultrasound-inotungamirwa radiofrequency ablation, microwave ablation uye laser ablation inopa inovimbisa imwe nzira yekuvhiya kana gomarara rethyroid rine njodzi shoma richida kurapwa. Kunyangwe nzira dzekuita dzeidzi nzira nhatu dzekubvisa dzakati siyanei, dzakafanana maererano nematanho ekusarudza bundu, mhinduro yebundu, uye matambudziko epashure. Parizvino, vanachiremba vakawanda vanobvumirana kuti chimiro chechirwere chebundu chekupindira zvishomanana ndeyemukati wetroroid papillary carcinoma <10 mm muhupamhi uye> 5 mm kubva kune zvinopisa zvinopisa zvakadai se trachea, esophagus, uye recurrent laryngeal nerve. Dambudziko rinowanzoitika mushure mekurapwa kunoramba kusingazivikanwe kupisa kukuvara kune inodzokororwa laryngeal tsinga iri pedyo, zvichikonzera kwechinguvana hoarseness. Kuti uderedze kukuvadzwa kwezvivakwa zvakapoteredza, zvinokurudzirwa kusiya chinhambwe chakachengeteka kubva kune chironda chinotarisirwa.

Tsvakurudzo dzinoverengeka dzakaratidza kuti kupindira kusinganyanyi kupindira mukurapa kwethyroid papillary microcarcinoma kune kushanda kwakanaka uye kuchengeteka. Kunyange zvazvo kupindira kuduku kwepapillary thyroid gomarara kwakapa migumisiro inovimbisa, zvidzidzo zvakawanda zvave zvichidzokororwa uye zvakatarisa kuChina, Italy, uye South Korea. Mukuwedzera, pakanga pasina kuenzanisa kwakananga pakati pekushandiswa kwezvishoma zvishoma zvinopindira uye kuongorora kushingaira. Naizvozvo, ultrasound-inotungamirwa thermal ablation inokodzera chete kune varwere vane njodzi yakaderera yegomarara rethyroid avo vasiri kukwikwidza kurapwa kwekuvhiya kana vanosarudza iyi nzira yekurapa.

Mune ramangwana, kune varwere vane kliniki yakakosha kenza yekenza, minimally invasive interventional therapy inogona kuva imwe nzira yekurapa ine ngozi yakaderera yezvinetso pane kuvhiyiwa. Kubva 2021, nzira dzekupisa dzekupisa dzakashandiswa kurapa varwere vane gomarara regomarara pasi pe38 mm (T1b~T2) vane hunhu hwakanyanya. Zvisinei, izvi zvidzidzo zvekare zvaisanganisira boka duku revarwere (kubva ku12 kusvika ku172) uye nguva pfupi yekutevera (kureva 19.8 kusvika kumwedzi 25.0). Nokudaro, kutsvakurudza kwakawanda kunodiwa kuti unzwisise kukosha kwekupisa kwekupisa mukurapa kwevarwere vane kenza yakakosha yekiriniki.

Kuvhiyiwa kunoramba kuri nzira yekutanga yekurapa kune vanofungidzirwa kana cytologically yakasimbiswa differentiated thyroid carcinoma. Pakave nekukakavadzana pamusoro peiyo yakanyanya kufanirwa chiyero chethyroidectomy (lobectomy uye yakazara thyroidectomy). Varwere vane thyroidectomy yakazara vari panjodzi huru yekuvhiya kupfuura avo vari kuita lobectomy. Njodzi dzekuvhiyiwa kwegororo dzinosanganisira kukuvara kwetsinga dzelaryngeal, hypoparathyroidism, matambudziko eronda, uye kudiwa kweiyo thyroid hormone supplementation. Kare, thyroidectomy yakazara ndiyo yaifarirwa kurapwa kune ese akasiyana egomarara rethyroid> 10 mm. Nekudaro, chidzidzo che2014 naAdam et al. yakaratidza kuti pakanga pasina mutsauko wakakosha mukupona uye njodzi yekudzokazve pakati pevarwere vari kuita lobectomy uye yakazara thyroidectomy ye 10 mm kusvika 40 mm papillary thyroid cancer pasina makiriniki ane njodzi yakanyanya.

Nokudaro, ikozvino, lobectomy inowanzosarudzwa kune unilateral zvakanaka-yakasiyana-siyana kenza yekenza <40 mm. Yese thyroidectomy inowanzokurudzirwa kune yakanyatso patsanurwa yethyroid cancer ye40 mm kana yakakura uye bilateral thyroid cancer. Kana bundu racho rapararira kune lymph nodes munharaunda, kuparadzaniswa kwepakati uye lateral lymph nodes yemutsipa inofanira kuitwa. Varwere chete vane medullary thyroid cancer uye mamwe akasiyaniswa akakura-vhoriyamu kenza yethyroid, pamwe nevarwere vane ekunze thyroid aggression, vanoda prophylactic central lymph node dissection. Prophylactic lateral cervical lymph node dissection inogona kutariswa kune varwere vane medullary thyroid cancer. Muvarwere vane fungidziro yenhaka medullary thyroid carcinoma, plasma mazinga e norepinephrine, calcium, uye parathyroid hormone (PTH) inofanira kuongororwa vasati vavhiyiwa kuti vaone MEN2A syndrome uye kudzivisa kushayikwa pheochromocytoma uye hyperparathyroidism.

Nerve intubation inonyanya kushandiswa kubatanidza neakakodzera tsinga yekutarisa kuti ipe unobtrusive airway uye kutarisa intraoperative tsandanyama uye tsinga basa mudokoriro.

EMG Endotracheal Tube Chigadzirwa tinya apa