甲状腺癌真的是“好癌”吗？要不要手术？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/WpnEBziaB4SOibgGmBMp5CTLDgNe2iaM7O5bkol2tpO2dJf1o7ibMh3SficXNgXAtLQUicTlt4C7dbjouD00M9zZjK1A/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">全世界甲状腺癌的发病率正在<span style="color: black;">提升</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在国内，<span style="color: black;">发掘</span>甲状腺癌的<span style="color: black;">病人</span>越来越多。<span style="color: black;">都数</span><span style="color: black;">病人</span>会<span style="color: black;">选取</span><span style="color: black;">即时</span>手术切除癌肿。<span style="color: black;">因此</span>，做甲状腺癌手术的<span style="color: black;">病人</span><span style="color: black;">亦</span>越来越多。<span style="color: black;">大众</span><span style="color: black;">发掘</span>，甲状腺癌整体而言，预后很好，<span style="color: black;">存活</span>率<span style="color: black;">亦</span>比较高，对人体的<span style="color: black;">危害</span>和<span style="color: black;">害处</span><span style="color: black;">亦</span>比较低，<span style="color: black;">因此</span>不管是专业人士还是普通<span style="color: black;">公众</span>都将甲状腺癌<span style="color: black;">叫作</span>为“好癌”。可有人就提出来了，既然是“好癌”，<span style="color: black;">倘若</span>不手术会不会<span style="color: black;">亦</span><span style="color: black;">无</span>什么问题呢？</span></p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/ULhiclwUibBSfTR9EgnUyTGAmZLJZb8IoXsPvFWEQPcCMj66cxVD9IktIEGqGT7mklfgiamfRiaD3zpX2CxquCsk3g/640?wx_fmt=jpeg&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">“好癌”具备的<span style="color: black;">前提</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近年来，甲状腺癌患病人数的<span style="color: black;">增多</span>，<span style="color: black;">重点</span>是<span style="color: black;">由于</span>微小乳头状癌的检出率<span style="color: black;">增多</span>了。微小乳头状癌<span style="color: black;">指的是</span><span style="color: black;">体积</span>不超过1厘米的甲状腺癌。<span style="color: black;">所说</span>“好癌”，<span style="color: black;">首要</span>要满足的<span style="color: black;">前提</span><span style="color: black;">便是</span><span style="color: black;">体积</span>不超过1厘米。<span style="color: black;">另外</span>，“好癌”还应该是低<span style="color: black;">危害</span>的甲状腺癌。<span style="color: black;">那些</span>是低<span style="color: black;">危害</span>的甲状腺癌呢？肿瘤不超过1厘米，<span style="color: black;">无</span>淋巴结转移和远处转移，肿瘤<span style="color: black;">无</span>突破甲状腺包膜到甲状腺外，<span style="color: black;">无</span>侵犯气管、喉返神经以及甲状腺<span style="color: black;">周边</span>组织，穿刺病理不是高危类型（<span style="color: black;">例如</span>乳头状癌）。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">手术的<span style="color: black;">消极</span>影响</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">低<span style="color: black;">危害</span>的乳头状甲状腺癌的传统治疗<span style="color: black;">办法</span>，<span style="color: black;">便是</span><span style="color: black;">所有</span>或部分切除甲状腺，<span style="color: black;">包含</span>乳头状微小癌（直径<span style="color: black;">少于</span>1厘米）<span style="color: black;">或</span>更大的乳头状癌。手术做完后，<span style="color: black;">病人</span><span style="color: black;">常常</span><span style="color: black;">必须</span>终身<span style="color: black;">吃下</span>甲状腺激素来替代治疗，有的时候还<span style="color: black;">必须</span>进行放射性碘131治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">日前</span><span style="color: black;">非常多</span>人存在一个误区，认为手术在很大程度上减轻了<span style="color: black;">病人</span>的痛苦，<span style="color: black;">因此</span>甲状腺癌的治疗首选手术。然而，<span style="color: black;">近期</span>的<span style="color: black;">科研</span><span style="color: black;">显示</span>，与<span style="color: black;">病人</span>的症状和认知相比，<span style="color: black;">大夫</span>可能低估了甲状腺癌手术治疗的<span style="color: black;">消极</span>影响。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在甲状腺切除术后，<span style="color: black;">病人</span>经常会<span style="color: black;">显现</span>吞咽或发声方面的不适。<span style="color: black;">有些</span><span style="color: black;">病人</span><span style="color: black;">亦</span>会受到<span style="color: black;">连续</span>性疲劳和不良心理的影响。疲劳<span style="color: black;">一般</span>是<span style="color: black;">因为</span>切除甲状腺后甲状腺素水平<span style="color: black;">反常</span><span style="color: black;">引起</span>的。心理方面的<span style="color: black;">困惑</span>，<span style="color: black;">重点</span><span style="color: black;">包含</span>对癌症复发的恐惧。这种恐惧可能会在手术治疗后<span style="color: black;">连续</span>数年，<span style="color: black;">况且</span>高达48%的甲状腺癌<span style="color: black;">病人</span>术后会产生这种恐惧，<span style="color: black;">病人</span>的生活质量受到严重影响。<span style="color: black;">病人</span>对治疗及其效果的不确定性和对<span style="color: black;">检测</span>结果的预期，会加剧担忧和焦虑心理。例如，甲状腺球蛋白有时<span style="color: black;">能够</span><span style="color: black;">做为</span>判断肿瘤<span style="color: black;">是不是</span>复发转移的指标，<span style="color: black;">必须</span><span style="color: black;">定时</span>检测。<span style="color: black;">病人</span>在甲状腺球蛋白的<span style="color: black;">检测</span>结果出来之前，会忐忑不安，紧张焦虑。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">更好的治疗<span style="color: black;">选取</span>：积极监测随访</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日本外科<span style="color: black;">大夫</span>士宫崎骏（Akira Miyauchi）向传统的甲状腺癌外科治疗模式提出了挑战。1993年，他<span style="color: black;">起始</span>对日本库马医院的甲状腺癌<span style="color: black;">病人</span>进行积极监测<span style="color: black;">科研</span>，为期22年。<span style="color: black;">所说</span>积极监测<span style="color: black;">便是</span>主动对甲状腺癌<span style="color: black;">病人</span>进行密切随访，而不是直接做手术，除非有<span style="color: black;">疾患</span><span style="color: black;">发展</span>的证据或<span style="color: black;">病人</span>的意愿<span style="color: black;">出现</span>了变化。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">日前</span>，人们对低<span style="color: black;">危害</span>甲状腺癌积极监测随访的兴趣正日益<span style="color: black;">增多</span>。日本同行的<span style="color: black;">科研</span>中有1179名<span style="color: black;">病人</span>接受了积极的监测，并接受了平均47个月的随访，没有<span style="color: black;">出现</span>甲状腺癌死亡，<span style="color: black;">无</span><span style="color: black;">病人</span><span style="color: black;">出现</span>远处转移。1179名<span style="color: black;">病人</span>中的1085名（92.0%）避免了甲状腺切除术，<span style="color: black;">仅有</span>51名<span style="color: black;">病人</span>（4.3%）在<span style="color: black;">无</span>甲状腺癌<span style="color: black;">发展</span>的<span style="color: black;">状况</span>下，因个人意愿，<span style="color: black;">最后</span>进行了甲状腺切除术。这个<span style="color: black;">科研</span><span style="color: black;">显示</span>，<span style="color: black;">病人</span>对<span style="color: black;">选取</span>这一治疗<span style="color: black;">办法</span>的<span style="color: black;">长时间</span>接受度很高。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日本的这个小组还深入<span style="color: black;">科研</span>了这些<span style="color: black;">病人</span>的心理认知<span style="color: black;">状况</span>。他们<span style="color: black;">发掘</span>，尽管超过1/3的<span style="color: black;">病人</span>报告说会担心自己的癌症，但有83%的<span style="color: black;">病人</span>对接受积极的监测感到满意。<span style="color: black;">她们</span>的担心程度以及担心的比例随着时间的推移而下降。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">该<span style="color: black;">科研</span><span style="color: black;">发掘</span>，<span style="color: black;">病人</span>的担心<span style="color: black;">源自</span>于对癌症<span style="color: black;">发展</span>的担忧或<span style="color: black;">必须</span>手术治疗的恐惧。<span style="color: black;">她们</span>还担心，<span style="color: black;">因为</span>恶性肿瘤<span style="color: black;">发展</span>会<span style="color: black;">导致</span><span style="color: black;">有些</span>症状，或接受手术治疗可能<span style="color: black;">显现</span><span style="color: black;">有些</span>并发症。笔者将这项研究<span style="color: black;">发掘</span>与甲状腺癌<span style="color: black;">病人</span>接受手术治疗的<span style="color: black;">科研</span>论文进行间接比较，<span style="color: black;">发掘</span>积极的监测不<span style="color: black;">必定</span>会加剧与癌症<span style="color: black;">关联</span>的担忧。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_png/ULhiclwUibBSfTR9EgnUyTGAmZLJZb8IoXYYnecgRkOgia8R4BbMhCEysqXolyIOChAnOWuzAF1cPGYIZVdgGP9qw/640?wx_fmt=png&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">“癌症不发展，<span style="color: black;">为何</span>要手术？”，<strong style="color: blue;"><span style="color: black;">满足<span style="color: black;">那些</span><span style="color: black;">前提</span><span style="color: black;">能够</span>暂时不手术</span></strong></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">针对</span>这个问题，<span style="color: black;">日前</span>在全世界进行的<span style="color: black;">科研</span><span style="color: black;">已然</span>给出了答案。<span style="color: black;">针对</span>低<span style="color: black;">危害</span>的甲状腺癌，是<span style="color: black;">能够</span>观察、积极监测的，不<span style="color: black;">必定</span>非得做手术。然而，<span style="color: black;">针对</span><span style="color: black;">大夫</span><span style="color: black;">来讲</span>，<span style="color: black;">要紧</span>的是除了<span style="color: black;">必须</span>知晓甲状腺癌诊断、治疗和随访的<span style="color: black;">要紧</span>性，还要充分知晓<span style="color: black;">病人</span>对支持性治疗的需求。<span style="color: black;">针对</span><span style="color: black;">病人</span><span style="color: black;">来讲</span>，就<span style="color: black;">必须</span>充分知晓自己的病情，积极<span style="color: black;">协同</span><span style="color: black;">大夫</span>进行随访，与<span style="color: black;">大夫</span>进行积极有效的沟通。</span></p><span style="color: black;">低<span style="color: black;">危害</span>甲状腺癌<span style="color: black;">倘若</span>能够满足以下<span style="color: black;">前提</span>，就<span style="color: black;">能够</span><span style="color: black;">思虑</span>暂时不手术，<span style="color: black;">然则</span>要密切观察。</span><span style="color: black;">1.肿瘤<span style="color: black;">少于</span>1厘米。</span><span style="color: black;">2.<span style="color: black;">无</span>淋巴结转移或远处转移。</span><span style="color: black;">3.肿瘤<span style="color: black;">无</span>突破甲状腺包膜到甲状腺外，<span style="color: black;">无</span><span style="color: black;">显现</span>气管、喉返神经以及甲状腺<span style="color: black;">周边</span>的侵犯。</span><span style="color: black;">4.穿刺病理不是高危类型。</span><span style="color: black;">5.<span style="color: black;">无</span>甲状腺癌家族史。</span><span style="color: black;">6.<span style="color: black;">没</span>青少年或童年时期射线暴露史。</span><span style="color: black;">7.<span style="color: black;">病人</span>心理压力不大，能积极<span style="color: black;">协同</span>。</span><span style="color: black;">8.<span style="color: black;">病人</span>有接受随访的意愿，<span style="color: black;">自己</span>健康<span style="color: black;">情况</span><span style="color: black;">准许</span>，有<span style="color: black;">前提</span>接受随访。</span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">文案</span><span style="color: black;">源自</span>：《<span style="color: black;">公众</span>健康》杂志、健康中国</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">作者：北京协和医院基本外科副<span style="color: black;">专家</span>医师 徐协群</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">审核：国家健康科普专家库专家 北京协和医院基本外科教授 林国乐</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">策划：谭嘉 余运西</span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;">举荐</span>阅读：</strong></span><a style="color: black;"><span style="color: black;"><strong style="color: blue;">1. 真实病例：<span style="color: black;">病患</span>“癌王”，多次复发、6次手术，80岁老人带瘤<span style="color: black;">存活</span>10余年</strong></span></a><a style="color: black;"><span style="color: black;"><strong style="color: blue;">2. 3分钟读懂：MSI、MMR、林奇<span style="color: black;">综合症</span>怎么区分？</strong></span></a><a style="color: black;"><span style="color: black;"><strong style="color: blue;">3. 肿瘤骨转移≠<span style="color: black;">没</span>药可医！这几个<span style="color: black;">方法</span><span style="color: black;">意见</span></strong></span></a><strong style="color: blue;"><span style="color: black;">保藏</span>！</strong><a style="color: black;"><span style="color: black;"><strong style="color: blue;">4. NEJM：一次注入162亿免疫细胞，肿瘤病灶消失72%，TCR-T疗法<span style="color: black;">导致</span>轰动！</strong></span></a><a style="color: black;"><span style="color: black;"><strong style="color: blue;">5. 2种<span style="color: black;">平常</span><span style="color: black;">低价</span>药，可大幅降低肿瘤<span style="color: black;">病人</span>术后转移<span style="color: black;">危害</span>！</strong></span></a><a style="color: black;"><span style="color: black;"><strong style="color: blue;">6. 4年总<span style="color: black;">存活</span>率89.8%！这类高危<span style="color: black;">初期</span>乳腺癌<span style="color: black;">病人</span>接受新治疗方式，<span style="color: black;">明显</span>改善<span style="color: black;">存活</span><span style="color: black;">状况</span></strong></span></a><a style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">7. <span style="color: black;">中国结直肠癌肝转移诊断和综合治疗指南（2023版）</span></span></strong></span></a><a style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">8. <span style="color: black;">NSCLC的</span></span></strong></span></a><strong style="color: blue;">肿瘤细胞可塑性：SCLC转化的起源争议</strong><span style="color: black;"><strong style="color: blue;"><span style="color: black;">——本期完——</span></strong></span><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">咱们</span>（医世象，<span style="color: black;">微X</span>ID：medhealife）</span></strong></span><span style="color: black;">致力于肿瘤<span style="color: black;">行业</span>的<span style="color: black;">研究</span>成果<span style="color: black;">报告</span>，以及科普知识的传播；</span><span style="color: black;">关注于肿瘤预防、早筛早诊、治疗以及<span style="color: black;">恢复</span>管理等肿瘤全生命周期管理</span><span style="color: black;">为<span style="color: black;">大夫</span>、<span style="color: black;">病人</span>以及<span style="color: black;">关联</span>人员<span style="color: black;">供给</span>最新的实讯；</span><span style="color: black;">为医学惠民贡献一份力量。</span><img src="https://mmbiz.qpic.cn/mmbiz_jpg/WpnEBziaB4SOibgGmBMp5CTLDgNe2iaM7O5kcianTs1epTPficopBag6y6N7RRFnqNeAd9yr14X8fnH4B38N5MnUWUw/640?wx_fmt=jpeg&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;">
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