甲状腺微小乳头状癌的诊治:附47例报告

发布时间：2018-08-20 07:49

【摘要】：目的:探讨甲状腺微小乳头状癌(PTMC)的临床病理特征及诊治策略。方法:回顾性分析2011年6月—2016年5月经手术与病理证实的47例PTMC患者临床资料。结果:47例患者中,男9例,女38例;年龄(46.3±12.1)岁;病程(12.4±23.7)个月;均行术前超声检查,14例行超声引导下细针穿刺细胞学检查(FNA),经FNA确诊PTMC 11例(78.6%);13例行患侧甲状腺全切,3例行患侧甲状腺全切+对侧叶大部切除术,31例行双侧甲状腺全切;14例行中央区颈淋巴结清扫术,15例行中央区加颈侧区淋巴结清扫。肿瘤病灶平均长径(0.68±0.23)cm;21例(44.7%)为多发病灶,其中14例(29.8%)为双侧甲状腺多发病灶;中央区淋巴结转移率48.3%(14/29),颈侧区淋巴结转移率53.3%(8/15)。单因素分析显示,肿瘤侵犯包膜与淋巴结转移有关(P=0.035)。8例患者术后发生并发症,其中暂时性甲状旁腺功能不全5例,切口积液1例,暂时性喉返神经损伤1例,暂时性喉上神经损伤1例。结论:甲状腺外科医生需熟悉甲状腺癌超声特点,不建议扩大FNA指征。对于术前超声已提示多发结节、术中探查可疑多发结节或存在高危因素者,手术建议行双侧甲状腺全切。预防性中央组淋巴结清扫结合术中冷冻病理对确定个体化手术方案及指导术后治疗是必要的。
[Abstract]:Objective: to investigate the clinicopathological features, diagnosis and treatment of (PTMC) in thyroid micropapillary carcinoma. Methods: the clinical data of 47 patients with PTMC confirmed by operation and pathology from June 2011 to May 2016 were analyzed retrospectively. Results among 47 patients, 9 were male and 38 were female, the age was (46.3 卤12.1) years, the course of disease was (12.4 卤23.7) months. All patients underwent ultrasound examination before operation and 14 cases underwent ultrasound guided fine needle aspiration cytology (FNA),). 11 cases (78.6%) of PTMC were confirmed by FNA. 13 cases (78.6%) underwent total thyroidectomy on the affected side. 3 cases were treated with total thyroidectomy and 31 cases with bilateral thyroidectomy. 14 cases underwent central neck lymph node dissection and 15 cases underwent central and lateral neck lymph node dissection. The mean long diameter of tumor was (0.68 卤0.23) cm ~ (-1) in 21 cases (44.7%), in which 14 cases (29.8%) were multiple thyroid lesions, the lymph node metastasis rate in the central region was 48.3% (14 / 29), the lymph node metastasis rate in the cervical region was 53.3% (8 / 15). Univariate analysis showed that tumor invasion and capsule involvement were associated with lymph node metastasis in 8 patients with postoperative complications, including temporary parathyroid dysfunction in 5 cases, incisional effusion in 1 case, and temporary recurrent laryngeal nerve injury in 1 case. Temporary superior laryngeal nerve injury in 1 case. Conclusion: thyroid surgeons should be familiar with the ultrasonic features of thyroid cancer and should not extend FNA indications. Bilateral total thyroidectomy is recommended for those with multiple nodules identified by ultrasound before operation, suspicious multiple nodules or high risk factors during operation. Preventive central group lymph node dissection combined with intraoperative cryopreservation is necessary to determine individual operation plan and guide postoperative treatment.
【作者单位】：中日友好医院普通外科;
【分类号】：R736.1

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