事件记录
面试官: 甲状腺癌手术期间和之后会发生什么. 外科肿瘤学家, Dr. 杰森·亨特，告诉大发娱乐整个过程.
甲状腺癌手术
Dr. 亨特: So day of surgery, you'll meet your surgeon, and you'll meet your anesthesiologist. 这些手术是在全身麻醉下进行的. 所以你在手术期间是睡着的. 然后你再回到手术室. One of the worst things about the operating room is it's really cold in the room. 所以大发娱乐试着给病人温暖的毯子，让他们感到舒适. Your anesthesiologist will be the one who'll help to keep you safe and help to keep you obviously asleep for the whole procedure.
手术方式：肺叶切除和神经保存
For performing a lobectomy, typically we try to make a pretty small incision. 这些切口通常只有两英寸或更小. 大发娱乐进去，切除那一半的甲状腺.
大发娱乐必须绕过很多重要的结构, and the biggest one is there's something called the recurrent laryngeal nerve or we can call it the nerve to the voice box. 你知道, 这是经常发生的, 如果你担心, that's the big one that people are worried about because if that nerve is injured, 我不知道麦克风能不能传过来, 但你的声音是这样的. 如果发生这种情况，你的声音就会带着呼吸声. 现在, 有时会发生这种情况，因为癌症已经生长到神经中, or sometimes that can happen because during surgery we have to push the nerve out of the way from the thyroid and it can be inadvertently stretched or damaged in that process. 现在，这种情况发生的频率是多少? 幸运的是，这种情况并不常见. 大概有2%的几率会出现暂时性的声音无力, 大约有1%的人会成为永久性的问题.
面试官: And that's something you don't necessarily know before you go in for surgery, 是否已经发展成那样?
Dr. 亨特: No.
面试官: 好吧.
Dr. 亨特: 不，不总是这样. 我的意思是，有时病人进来说，“你知道，我的声音很弱.“然后大发娱乐会带上一个小相机, 它和一大块意大利面差不多大, and we actually go through the nose with this camera and look at their voice box. 但如果病人在其他方面是正常的, sometimes we get in there and we still find that the cancer is involving the nerve. 这是不幸的事情之一. 大发娱乐之前谈过很多. 大发娱乐可以在手术中做一些事情. Sometimes we will monitor the movement of the vocal cords with a special type of tube. 所以当他们插管时, we place a special tube that can kind of monitor the movement of the vocal folds.
And if it happens, there are some things that can be done to make it better. We have some voice specialists who can do collagen injections to the voice box, 有时大发娱乐做神经移植. And so we can get the voice back to near normal with some of those other treatments.
甲状腺手术的潜在风险和并发症
The other thing we have to talk about is there's a small risk of bleeding. 这种手术有感染的小风险. 然后 there are these little glands that live near the thyroid called parathyroid glands. 甲状旁腺控制着你体内的钙含量. 两边各有两个. 除此之外，它们与甲状腺没有任何关系. Now this is another advantage of taking out half the thyroid versus 所有的一切 because you only need one out of the four. So if we just stick to half the thyroid, then there is a 0% chance that you'll get calcium problems. 而不是把所有的都取出来, then there is a small chance of having some calcium issues postoperatively or after surgery.
在大发娱乐取出甲状腺后，大发娱乐闭合切口. 如果大发娱乐把一半的甲状腺切除, 通常大发娱乐会在当天进行手术, 意思是你当天就可以回家. 如果大发娱乐把甲状腺都取出来, 然后他们中的一些人可以在同一天回家, 但有些人需要在手术前过夜.
面试官: 好吧. 这个切口会 . . . 我之后会留疤吗 . . .
Dr. 亨特: 你知道，大发娱乐没有没有疤痕的切口，但大发娱乐 . . . 很明显大发娱乐一直都在大发娱乐工作，所以大发娱乐 . . . 这条细线愈合得很好, 这也是大发娱乐把切口做小的另一个原因, 这样伤疤就不会那么大了. 大发娱乐确实有一些治疗疤痕的方法, so patients can do things such as try to avoid sun exposure on their scars. There are some, 你知道, vitamin E oil is a common thing that we recommend. 然后 also sometimes you can use some silicone strips on the scar that'll help to decrease the scarring.
面试官: 是的. 你在脖子的什么地方做了那个切口?
Dr. 亨特: 在脖子的下部，在中间. So kind of about an inch above your collarbone, in the midline of the neck.
术后护理与康复
面试官: 手术后, what can a patient expect in terms of recovery time before they can go back to kind of their normal life?
Dr. 亨特: 是的. 所以，你知道，这是 . . . 做这个手术时，大发娱乐得活动一些肌肉. 所以我告诉病人，这更像是肌肉拉伤，而不是剧烈疼痛. For most patients nowadays, we actually do this without the use of narcotics postoperatively. 所以大发娱乐让病人交替服用泰诺和布洛芬. 95%的情况下, 大发娱乐不需要使用麻醉剂, 这意味着更快的恢复, 更少的停机时间.
至于停机时间, 大发娱乐在手术后的第二天告诉病人, 你可以出去了, 你可以去散步. 你知道, we don't want you lifting anything heavy that might actually kind of bring bleeding, 这可能会打开血管. 所以一个星期左右，大发娱乐建议不要举重. 我告诉病人, 如果你有严格的锻炼计划, 如果你是滑雪者, 你知道, 一个骑摩托车的人, you probably want to not do that to kind of the same degree until two weeks.
面试官: 好吧. 比如说，一个人在办公室或办公室工作, 他们可以回去工作了, 这听起来, 很快. Maybe, somebody who is in physical labor would need to take a little bit more recovery time.
Dr. 亨特: 是的，没错. 我的意思是，我有一些病人第二天就会回去工作. 我觉得这可能有点太快了, 但, 你知道, 通常几天后你就可以回到办公室工作了.
面试官: 是的. 我是说，好好利用这段时间.
Dr. 亨特: 这是正确的.
面试官: 你刚做了甲状腺癌手术.
Dr. 亨特: 这是正确的. 是的.
面试官: 你有一两天的时间.
Dr. 亨特: 给自己留点时间.
面试官: 是的. After surgery, is there additional therapy that the individual would need to take care of?
Dr. 亨特: 你知道, 如果大发娱乐只取出一半的甲状腺, 通常没有, 因为如果大发娱乐这样做, then we're 说ing it's a low-grade cancer that has a low likelihood of coming back and we don't give radioactive iodine. 如果大发娱乐做甲状腺全切除术, 这些病人可能需要放射性碘, 大发娱乐通常会在六周后进行测试.
甲状腺癌手术后的随访和监测
面试官: 好吧. 然后, 你下次再来是什么时候, 和你的医疗保健专业人员, 只是为了监视，确保一切正常?
Dr. 亨特: 确定. 是的. 大发娱乐通常会在手术后一到两周看到病人回来. 然后, 对于癌症诊断, 大多数病人都会接受常规监测, looking for potential recurrence of cancer about every six months for the first two years, 然后每年一次，直到大约五年. And what that looks like is typically an ultrasound of the neck and then some blood work.
面试官: 好吧. 所以他们可以做到, 如果他们不住在他们做手术的中心附近, 他们有自己的本地供应商?
Dr. 亨特: Typically you do want to see an endocrinologist, though, to follow you on that. 是的.
手术后的副作用和健康考虑
面试官: 好吧. 然后 are there any sort of side effects or health problems that somebody should be aware of after surgery?
Dr. 亨特: 最大的问题与激素替代有关. 我的意思是, 大发娱乐讨论了手术的风险, 但是药物治疗, 医疗管理方面, 如果你的甲状腺被切除了, 所有的一切, 你必须服用甲状腺药物, 每天一颗药，终生服用. 这是一种非常非常常见的药物. And doctors are pretty good about honing in on that and getting it to the right level. 如果你切除一半的甲状腺, 大发娱乐需要检查一下, because sometimes that half of the thyroid doesn't provide enough of the thyroid hormone. 但对很多人来说, 就像我之前说的, 大约70%的病人, 一半的甲状腺会大发娱乐提供你所需的所有激素. 所以你需要做一些血液测试来监测.
Hormone Replacement Therapy and Managing Thyroid Hormone Levels After Thyroid Surgery
面试官: What are the side effects of not having enough thyroid hormone production?
Dr. 亨特: 对，甲状腺，那是你身体的马达. 所以如果你的甲状腺水平低，你就会感到疲倦. 你的体重会增加. 你可能会脱发. 你的眼睛周围会浮肿. 所以这是一种非常重要的药物. 你知道, if you're off of it for months and years, it can even affect your heart. So it is important to make sure that those levels have been adjusted appropriately.
复发风险及监测策略
面试官: 那么复发的几率是多少呢? And is there something I can do post-surgery to, 你知道, control that risk?
Dr. 亨特: 是的, 复发率, 如果你患的是低度癌症, 复发率约为10%, 它通常会回来, 说, in a lymph node or potentially it could come back in the other side of the thyroid gland. Taking all of the thyroid out doesn't significantly decrease that risk though. 这只是一个小数目. 所以大发娱乐建议在颈部进行自我检查. If you feel any lumps or bumps, obviously you want to get those checked out. But really the big thing is getting these periodic ultrasound evaluations. Typically, that's going to find something well before you could ever feel it.