甲状腺微小癌43例诊治分析

Diagnosis and treatment of thyroid microcarcinoma ： A report of 43 cases

目的探讨甲状腺微小癌的临床特点及其诊治方法。方法回顾分析1998年3月至2009年5月经手术和病理证实的43例甲状腺微小癌临床资料。结果术前B超检查发现18例可疑微小癌，术中冰冻切片检查证实36例甲状腺微小癌，可疑5例，33例伴有结节性甲状腺肿（76％），3例伴桥本病（6．9％）。主要术式为患侧腺叶、峡部和对侧腺叶大部切除术，其中5例行功能性颈淋巴结清扫。随访6个月～11年，未见复发和转移。结论甲状腺微小癌多伴有甲状腺良性结节性病变，术前B超及术中冰冻切片检查对提高甲状腺微小癌诊断率有重要价值，其手术治疗应根据有无淋巴结转移选择合适的术式。

Objective To investigate the clinical characteristics, diagnosis and treatment of thyroid microcarcinoma. Methods The clinical data of 43 patients with thyroid microcarcinoma who were admitted to our hospital from March 1998 to May 2009 were retrospectively analyzed. Results Eighteen patients were suspected of having thyroid microcarcinoma by preoperative B - ultrasonography. Thyroid microcarcinoma was confirmed in 36 patients and still suspected in 5 patients by frozen section examination during the operation. Thirty - three cases were accompanied with nodular goiter （76%） and 3 with Hashimoto＇s disease （6.9%）. The main operation type was total resection of the involved lobe and isthmus, and subtotal resection of contralateral lobe. Among the patients, 5 underwent functional lymphatic nodes dissection. All the patients were followed up for 6 months to 11 years and no patients recurred and developed metastasis. Conclusion Thyroid microcarcinoma is often complicated with benign thyroid nodules. Preoperative B - ultrasonography and intraoperative frozen section examination are valuable for the diagnosis of thyroid microcarcinoma. Optimal surgical procedures for thyroid microcarcinoma should be selected based on the status of lymph node metastasis.