分化型甲状腺癌全切术后复发的研究进展
Advances in Postoperative Recurrence of Differentiated Thyroid Cancer Following Total Thyroidectomy
摘要: 分化型甲状腺癌(Differentiated Thyroid Carcinoma, DTC)总体预后良好，但全切术后仍有部分患者面临局部复发或远处转移的风险。复发性DTC的治疗策略目前正经历从单一手术向多学科综合管理(MDT)模式的转变。再次手术仍是治疗结构性复发的首选方案，但在手术时机及手术方式的选择、并发症控制及替代疗法(如微波消融)的应用上仍存在探讨空间。此外，目前关于再次手术后是否需要再行放射性碘(RAI)治疗争议较大，循证医学证据趋向于更审慎的态度。对于复发难治性病例，TSH抑制治疗及主动监测提供了新的选择。本文就DTC全切术后复发的风险预测、手术治疗进展及综合管理策略综述如下。
Abstract: Although differentiated thyroid carcinoma (DTC) generally has an excellent overall prognosis, a subset of patients still faces the risk of locoregional recurrence or distant metastasis following total thyroidectomy. The treatment paradigm for recurrent DTC is currently transitioning from surgery alone to a multidisciplinary team (MDT) management approach. While reoperation remains the primary treatment of choice for structural recurrence, the optimal surgical timing and approach, the management of complications, and the application of alternative therapies (e.g., microwave ablation) remain subjects of ongoing debate. Furthermore, the necessity of adjuvant radioactive iodine (RAI) therapy following reoperation is highly controversial, with recent evidence-based medicine favoring a more prudent approach. For recurrent and refractory cases, thyroid-stimulating hormone (TSH) suppression therapy and active surveillance offer novel management options. This article reviews the recent progress in risk prediction, surgical interventions, and comprehensive management strategies for DTC recurrence following total thyroidectomy.
文章引用：万钊宇, 苏新良. 分化型甲状腺癌全切术后复发的研究进展[J]. 临床医学进展, 2026, 16(4): 4619-4624. https://doi.org/10.12677/acm.2026.1641734

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