甲状腺恶性肿瘤再手术最新研究进展

Research Advances in Reoperation for Malignant Thyroid Tumors

摘要: 甲状腺癌再手术是因初次手术不规范、术后复发或进展而进行的二次或多次手术，其技术难度和并发症风险显著高于初次手术。近年来，随着2025版美国甲状腺学会(ATA)指南的发布，甲状腺癌的全程管理理念发生了深刻变革——从传统的静态分期转向动态风险分层，从“一刀切”的治疗模式转向个体化的精准决策。在再手术领域，这些理念更新体现在三个层面：术前，动态风险评估体系和分子分型指导了更精准的手术适应证筛选；术中，带状肌外侧入路、神经监测、甲状旁腺自体荧光显像等技术创新显著降低了并发症发生率；术后，对于无法耐受或拒绝再次手术的患者，微波消融等局部治疗正成为重要的替代选项。本文系统梳理了甲状腺癌再手术的最新进展，涵盖适应证演变、术前评估策略、手术技术创新、并发症预防及替代治疗方案，以期为临床实践提供参考。

Abstract: Reoperation for thyroid cancer refers to secondary or multiple surgeries performed due to improper initial surgery, postoperative recurrence, or disease progression. Its technical difficulty and risk of complications are significantly higher than those of the initial surgery. In recent years, with the release of the 2025 American Thyroid Association (ATA) Guidelines, the concept of comprehensive management of thyroid cancer has undergone a profound transformation—from traditional static staging to dynamic risk stratification, and from a one-size-fits-all treatment model to individualized precision decision-making. In the field of reoperation, these updated concepts are reflected in three aspects: preoperatively, dynamic risk assessment systems and molecular subtyping guide more precise selection of surgical indications; Intraoperatively, technological innovations such as extrapleural platysma approach, nerve monitoring, and autologous parathyroid autofluorescence imaging have significantly reduced complication rates; Postoperatively, local treatments such as microwave ablation are emerging as important alternative options for patients who cannot tolerate or refuse reoperation. This article systematically reviews the latest advances in reoperation for thyroid cancer, covering the evolution of indications, preoperative evaluation strategies, surgical technological innovations, complication prevention, and alternative treatment options, aiming to provide reference for clinical practice.