甲状腺微小乳头状癌诊断和外科治疗的研究进展

发布时间：2018-03-23 23:00

本文选题：甲状腺微小乳头状癌　切入点：高分辨率超声　出处：《河北医科大学》2017年硕士论文

【摘要】：甲状腺微小乳头状癌(Papillary thyroidmicrocarcinoma PTMC)是最大直径≤10 mm的甲状腺乳头状癌,是甲状腺癌的一种亚型。近年来,随着人们健康意识的提高,以及高分辨率超声影像检查等新型辅助诊断方法在临床上的广泛应用,PTMC的检出率更是呈现出明显上升的趋势。如今,甲状腺癌的新增病例中,PTMC的占比已经达到50%以上。PTMC具有临床症状不典型、病情进展较为缓慢、体积较小不易检出等特点,临床上对于PTMC的早期发现和诊断还存一定的困难。与此同时,PTMC并非是PTC的早期癌或者癌前病变,有着与PTC相同生物学特性,存在局部浸润以及颈淋巴转移倾向。但由于绝大多数PTMC处于亚临床状态,发病隐匿,不影响患者生活质量,对于是否需要立即进行手术治疗,以及手术时对于原发灶的切除范围和是否需要预防性的进行局部淋巴结的清扫等方面还存在争议。随着诊断技术的进步,高分辨率超声、CT、MRI等影像学诊断技术以及细针穿刺活检、术中冰冻病理等病理诊断技术,在临床上的应用更加广泛,相应的研究也更加完善,诊断的准确率得到了极大的提升。PTMC治疗前的病情评估及治疗预案的制定也显得越发重要。大量的临床实践和研究总结表明,手术治疗依然是治疗甲状腺微小乳头状癌的首选治疗方法。传统的手术治疗方式中,治疗甲状腺微小乳头状癌时,甲状腺的切除范围主要有两种,即甲状腺腺叶+峡部切除和甲状腺全或近全切除。随着临床上的不断实践和总结改进,手术方式的选择更加细化、规范。同时,微创腔镜技术得到了广泛的推广,新型的手术治疗也将腔镜技术应用到了甲状腺疾病的治疗领域。目前应用比较广泛的是腔镜辅助的甲状腺切除术即Miccoli术式和完全腔镜甲状腺切除术,两种手术方式各有利弊,其适用范围及技术细节仍在进一步完善中。放射碘治疗、TSH抑制治疗等术后相关治疗也得到广泛应用,有效性也得到了进一步证实。本文将就甲状腺微小乳头状癌的诊断和外科治疗的研究进展进行综述。
[Abstract]:Papillary thyroidmicrocarcinoma thyroidmicrocarcinoma is a thyroid papillary carcinoma with a maximum diameter of less than 10 mm and a subtype of thyroid carcinoma. The detection rate of PTMC, as well as new assistant diagnostic methods such as high-resolution ultrasound imaging, has been increasing significantly in clinical practice. Among the new cases of thyroid cancer, the proportion of PTMC has reached more than 50%. PTMC has the characteristics of atypical clinical symptoms, slow progress of the disease, small size, difficult to detect, and so on. It is still difficult to detect and diagnose PTMC clinically. At the same time, it is not an early cancer or precancerous lesion of PTC, and has the same biological characteristics as PTC. There is a tendency of local infiltration and cervical lymphatic metastasis. However, because most of PTMC is in a subclinical state, the onset of the disease is concealed and does not affect the quality of life of the patients. There are still disputes about the scope of primary tumor resection and the need for preventive local lymph node dissection. With the development of diagnostic techniques, imaging diagnostic techniques such as high-resolution ultrasound and CT MRI and fine needle biopsy, Intraoperative frozen pathology and other pathological diagnosis techniques are more widely used in clinical practice, and the corresponding research is more perfect. The accuracy of diagnosis has been greatly improved. PTMC before the treatment of the disease evaluation and treatment planning is increasingly important. A large number of clinical practice and research summary shows that, Surgical treatment is still the first choice for the treatment of thyroid micropapillary carcinoma. Among the traditional surgical treatments, there are two main types of thyroidectomy in the treatment of thyroid micropapillary carcinoma. That is, thyroid gland isthmus resection and total or near total thyroidectomy. With the continuous practice and improvement in clinical practice, the choice of surgical methods is more detailed and standardized. At the same time, minimally invasive endoscopic technique has been widely popularized. The new surgical treatment also applies the endoscopic technique to the treatment of thyroid diseases. At present, endoscopic assisted thyroidectomy (Miccoli) and total endoscopic thyroidectomy (Miccoli) have both advantages and disadvantages. The scope of application and technical details are still being further improved. Radiation iodine therapy, TSH inhibition therapy and other postoperative related treatment are also widely used. This article reviews the diagnosis and surgical treatment of thyroid micropapillary carcinoma.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

【参考文献】