甲状腺微小癌102例诊治分析

Diagnosis and treatment of 102 cases of thyroid microcarcinoma

目的：总结甲状腺微小癌(TMC)的诊治体会。方法：分析1994年8月～2004年9月经手术和病理证实 的 TMC 102例临床资料。结果：102例经术中和术后病理确诊，占同期甲状腺癌手术23． 6%(102/432) 。其中乳头状 癌97例(占95． 1%)，滤泡状癌5例。伴颈淋巴结转移12例(11． 7%)。男女比1∶7． 5。术前仅确诊13例(12． 7%)。与 良性结节并存48例(47． 1%)。彩超示可疑声像76例，与病理符合率71． 1%(54/76) 。术中冷冻切片阳性率91． 8%(90/ 98) 。92例单发癌，10例多灶癌。随访2个月～10年，无复发及死亡。结论：TMC 多数在良性结节术中或术后病理发 现。重视术前彩超及术中冰冻切片可减少漏诊。患侧腺叶切除术作为常规术式以避免二次手术。区域淋巴结肿大应 同期行颈清术。TMC 预后佳，但术后仍需长期随访观察。

Objective To summarize the experience in the diagnosis and treatment of thyroid microcarcinoma（TMC）. Methods The clinical data of 102 cases of TMC admitted from Aug 1994 to Sept 2004 were analyzed. Results The diagnosis of the 102 cases were all confirmed by frozen section（FS） and postoperative pathological examination, The sum of microcarcinoma occupied 23.6%（102/432） of all the thyroid carcinomas seen within the same period. There were 97 （95%） cases of papillary carcinoma, 5 cases of follicular carcinoma; of these, 12（11.7%）cases were accompanied by lymph node metastasis. The ratio between male and female was 1：7.6. Only 13 cases were confirmed preoperatively; 48（47%） cases were found among the benign nod nodules; 76 cases were suspected during color Doppler uhrasonograthy（CDU）; and 71%（54/76） complied with the result of pathological examination. The positive rate of FS was 91.8 （90/98）. Ninety-two cases were monofocal cancer, 10 cases were muhifocal cancer. All patients were followed-up from 2 months to 10 years after operation. No recurrence occurred and all the patients are well alive. Conclusions Most of the TMC are found among the benign nodules during operation or within the pathological specimens. Preoperative CDU and FS are necessary to help the diagnosis. Lobectomy is the routine radical operation. Regional nodes metastases need simultaneous nodal clearance. The prognosis of TMC is better than the average thyroid cancer in the cases. But long duration postoperative follow-up is mandatory.