隐匿性甲状腺癌的诊断与治疗

DIAGNOSIS AND TREATMENT OF OCCULT THYROID CARCINOMA

目的 :探讨隐匿甲状腺癌的诊断与治疗。方法 :对 34例隐匿性甲状腺癌的临床资料进行分析。结果 :仅有 6例术前诊断隐匿性甲状腺癌。 1 6例行患侧腺叶及峡部切除术 ,1 4例加颈淋巴结清扫术 ,1 8例行双侧腺叶次全切除术。病理见 34例癌灶均位于单侧腺叶 ,有颈淋巴结转移者 4例 ,其中 3例癌灶已穿透甲状腺被膜。癌灶内及其周围的甲状腺组织内查见砂粒体者 1 5例。随访 6个月～ 2 0年 ,1例死于肺转移 ,2例死于其他疾病 ,余均健在。结论 :1甲状腺手术时应警惕并存隐性癌的可能性 ;2甲状腺组织内查到砂粒体 ,则为癌存在的信息 ;3治疗应选择一侧腺叶全切或次全切除术。癌灶已穿透甲状腺被膜者或已有颈淋巴结转移者 ,应行颈淋巴结清扫术。

Objective:To investigate the diagnosis and treatment of occult thyroid carcinoma.Methods:To analyse the clinical data of 34 cases of OTC retrospectively.Results:Only 6 cases were preoperatively diagnosed as OTC.Total thyroidectomy of the affected lobe and isthmus oas performed in 16 cases with neck dissection in 14 cases.Subtotal thyroidectomy was performed in 18 cases.The occult cancer lesion was pathologically found in lateral lobe in 34 cases.Neck lymph node metastasis was found in 4 cases and local infiltration in 3 cases.The psammoma bodies in cancer lesion and normal gland around were found in 15 cases.Follow up was done from six months to twenty years.One case died of lung metastasis,two died of other diseases,and the rest were alive.Conclusions:①Vigilance should be required for possible coexistence of OTC during thyroid operation.②The psammoma bodies in normal thyroid gland usually imply the existance of cancer.③Total thyroidectomy of a lobe or subtotal thyroidectomy is selected.Additional neck dissection should be performed for local infiltration or neck lymph node metastasis.