甲状腺微小癌诊治(附42例报告).docVIP

甲状腺微小癌的诊治(附42例报告) 　　作者：徐晓波，刘正尼 作者单位：200011 上海，上海交通大学医学院附属第九人民医院普外科 　　【摘要】 目的 探讨甲状腺微小癌的临床特征、诊断、治疗原则及预后。方法 回顾性分析2003年1月-2010年2月手术治疗的42例甲状腺微小癌的临床资料。结果 病理为乳头状癌40例(42侧)(95.24%)，滤泡状癌2例(4.76%)。行患侧腺叶+峡部+对侧次全切除+患侧中央区淋巴结清扫5例，其中3例行患侧改良性颈淋巴结清扫术;双侧全切2例;患侧腺叶+峡部+对侧次全切除26例;患侧腺叶+峡部1例;患侧腺叶切除8例。结论 B超有助诊断，手术方法多为患侧腺叶+峡部+对侧腺体次全切除术，预后较好。 　　【关键词】 甲状腺肿瘤;微小癌 　　Clinical study of thyroid microcarcinoma (42 cases) 　　XU Xiao-bo, LIU Zheng-ni.Department of General Surgery, Shanghai Ninth Peoples Hospital Affiliated to Shanghai Jiaotong Univercity School of Medicine,Shanghai 200011,China 　　[Abstract] Objective To analyze the clinical characteristics and prognosis, and to discuss the operation procedures for the thyroid microcarcinoma.Methods Data of 42 patients with thyroid microcarcinomas from January 2003 to February 2010 were analyzed retrospectively. Results 95.24% of all cases were papillary thyroid carcinoma; lobectomy of involved lobe with subtotal thyroidectomy of contralateral lobe was performed in 26 cases, lobectomy and isthmectomy in 1 case, lobectomy in 8 cases. Lymph node dissection of central group were performed in 5 cases, 3 of them had central compartment node metastases, then performed modified radical neck dissection.Conclusion B type ultrasound is the first choice for preoperative screening. Ipsilateral thyroid lobectomy with contralateral subtotal thyroidectomy is advocated. The prognosis is good. 　　[Key words] thyroid neoplasm; microcarcinoma 　　甲状腺微小癌(thyroid microcarcinoma，TMC)是指直径≤1cm的甲状腺癌[1]，起病隐匿，缺乏特异性临床表现, 检查时难以扪及，绝大多数病例是在甲状腺良性疾病手术中快速冰冻检查或术后病理常规检查得以确诊。笔者对42例经病理证实的甲状腺微小癌的临床资料作回顾性分析，现报告如下。 　　1 临床资料 　　1.1 一般资料 2003年1月-2010年2月，我科收治手术病理确诊的甲状腺微小癌42例。其中男8例，女34例，男女之比为1:4.25;年龄35～75岁，中位年龄52岁。临床表现：因颈前肿物入院39例，体检发现颈部肿块3例，均无声嘶、气促和吞咽困难等表现;病史7 天～10年不等。术后病理检查结果证实单侧微小癌灶40例,双侧微小癌灶2例,共42例44侧。 　　1.2 辅助检查 全组均行T3、T4和TSH检查，结果均在正常范围。高频彩色B超检查发现，39例(41侧)为实质性结节(92.86% )，边界不清楚; 2例(3侧)为含液性病灶(7.14% ); 10例(10侧)(23.81% )有细砂粒样钙化。B超术前诊断甲状腺癌10例(23.81% ) 。有2例行超声引导下细