甲状腺微小癌的临床研究

Thyroid microcarcimoma

目的探讨甲状腺微小癌的临床特征及治疗原则。方法回顾分析1997年1月至2006年12月收治的311例甲状腺微小癌的临床资料。结果181例患者以结节性甲状腺肿、甲状腺瘤等良性病变为首发症状（偶发组），130例患者以甲状腺癌结节或体检B超怀疑恶性病变或以颈部淋巴结转移为首发症状（显性组）。两组平均年龄分别为47岁及42岁（F=15．545，P=0．000）。显性组恶性程度高于偶发组，其需行颈淋巴结清扫的比例分别为48．5％（63／130）及30．9％（56／181），颈部淋巴结转移率分别为27．7％（36／130）及10．5％（19／181），肿瘤两叶多发病灶分别为18．5％（24／130）及9．4％（17／181）。结论将甲状腺微小癌分为“偶发癌”和“显性癌”两个亚型对认识微小癌的发生、发展及指导临床治疗具有实际意义。对“显性癌”患者，患侧腺叶切除或甲状腺全切除应视为标准术式；而对“偶发癌”患者，在保证安全切缘的前提下，甲状腺次全或腺叶切除都可视为手术选择。同时应常规探查Ⅵ区淋巴结，肿大者应予以清扫，体检及B超提示颈淋巴结转移者需再加颈侧清扫。

Objective To investigate the clinicopathologic features and treatment of thyroid microcarcinoma （TMC）. Methods From January 1997 to December 2006, 311 patients who underwent surgery and defined as TMC（ tumor size ≤ 1 cm）were enrolled. Results TMC was identified incidentally by frozen pathologic examination on thyroidectomy specimens in tentative benign goiters in 181 patients; another 130 patients with clinically detectable primary tumors or suspected nodal metastases were grouped to as clinically overt TMC. The clinically overt TMC had a higher incidence of bilateral multifocal tumors （ 18.5% vs. 9.4% ,P =0. 03）, and cervical lymph node metastases（27.7% vs. 10. 5% ,P =0. 000） than that in clinically occult TMC group. Conclusion TMC may vary considerably in clinical and biologic behaviors between these two subtypes： clinically overt and occult. Lobectomy for single lesion, total or near total thyroidectomy for multifocal with central compartment nodal dissection should be performed, lateral nodal dissection was not carried out unless US or physical examination detected nodal metastases. Lobetomy, subtotal or more limited thyroidectomy for occult TMC, diagnosed incidentally following thyroid surgery for initially tentative benign thyroid disease, could all be treatment of choice depending on the preference of surgeons.