72例甲状腺乳头状微小癌临床病理分析

Clinicopathological analysis of thyroid papillary microcarcinoma

目的探讨甲状腺乳头状微小癌(papillary thyroid microcarcinoma,PTM)的临床病理特点。方法回顾性分析72例PTM患者的临床资料。结果男性9例,女性63例,男女之比为1∶7,中位年龄分别为49岁和46岁。临床误诊率69.4%(50/72),采用甲状腺次全切29例,患叶切除术16例,患叶加峡部切除术13例,患叶及峡部及肿大淋巴结清扫术14例(19.4%),淋巴结转移率为85.7%(12/14),男性女性淋巴结转移率分别为100.0%(5/5)和77.8%(7/9)(χ2=1.296,P=0.255)。多灶15例,单结节57例,淋巴结转移率分别为75.0%(3/4)和90.0%(9/10)(χ2=0.525,P=0.469)。伴有结节性甲状腺肿38例,桥本甲状腺炎2例。病灶长径≥0.5cm者51例,淋巴结转移率为77.8%(7/9),<0.5cm者21例,淋巴结转移率为100.0%(5/5)(χ2=1.296,P=0.255)。≥45岁39例,<45岁33例,淋巴结转移率分别为100.0%(8/8)和66.7%(4/6)(χ2=3.111,P=0.078)。结论 PTM是一种慢性病,临床误诊率较高。在对扪及的肿大淋巴结进行治疗性清扫的PTM病例中,淋巴结转移率极高,但性别、年龄、癌灶数目及大小等因素与PTM淋巴结转移率相关性之间的差异无统计学意义。

Objective To analyze the clinicopathological characteristics of thyroid papillary microcarcinoma（PMCT） .Methods The clinical and pathological data of 72 cases of PMCT with lymph node metastasis were retrospectively reviewed.Results The patients included 9 males and 63 females,with the median onset age of 49 and 46,respectively.The clinical misdiagnosis rate was 69.4%（50/72） .Fourteen cases,including 5 males and 9 females,underwent lymph nodes dissection and lymph node metastasis was detected in 12 cases（85.7%） .In this group of patients the lymph node metastasis rate of males and females was 100.0%（5/5） and 77.8%（7/9）（χ2=1.296,P=0.255） ,respectively;that of multifocal lesions and single nodules was 75.0%（3/4） and 90.0%（9/10）（χ2=0.525,P=0.469）;that for lesions ≥0.5 cm and M〈0.5 cm was 77.8%（7/9） and 100.0%（5/5）（χ2=1.296,P=0.255） ,respectively;that for those over 45 y and below 45 y was 100.0%（8/8） and 66.7%（4/6）（χ2=3.111,P=0.078） ,respectively.Conclusions Thyroid papillary microcarcinoma is a chronic disease with high clinical misdiagnosis rate.In patients with lymph node dissection the rate of lymph node metastasis is high,which is not significantly correlated with sex,age,size and numbers of the tumor.