结节性甲状腺肿合并乳头状微癌的临床研究

Clinical analysis of nodular goiter with coexistent thyroid papillary microcarcinoma

目的探讨结节性甲状腺肿合并乳头状微癌的术前诊断、手术方式选择以及再次扩大切除的指征。方法回顾我院近4年结节性甲状腺肿合并乳头状微癌患者的临床资料。结果所有患者术前、术中均未能明确诊断合并乳头状微癌,确诊依靠术后石蜡切片病理检查。87例患者中4例行再次扩大切除术及预防性中央区淋巴结清扫,术后再次病理切片检查未发现癌残留及颈部淋巴结转移。结论结节性甲状腺肿合并乳头状微癌术前诊断困难,确诊依靠术后石蜡切片病理检查,但患者预后良好。对于结节性甲状腺肿患者,甚至一些小结节占位性病变,应考虑合并甲状腺癌的可能,故应积极手术干预。

Objective To review the preoperative diagnosis, surgical options and Indications for reoperation of nodular goiter with existent thyroid papillary microcarcinoma. Methods The clinical and pathological data of 87 cases of nodular goiter with existent thyroid papillary microcarcinoma treated in our department from 2007 to 2011 were retrospectively reviewed. Results All cases were diagnosed by paraffin histopathology. Four cases underwent extended reoperation and neck lymph node dissection. No one case had residual cancer and lymph node metastasis. Conclusion Nodular goiter with existent thyroid papillary microcarcinoma can be diagnosed by paraffin histopathology. Surgery treatment should be actively adopted, including the small nodules.