多灶性甲状腺微小乳头状癌临床病理特征分析及中央区淋巴结清扫的意义

Clinicopathological characteristics of multifocal papillary thyroid microcarcinoma and the meaning of prophylactically central lymph node dissection

目的探讨多灶性甲状腺微小乳头状癌临床病理特征及中央区淋巴结清扫的意义。方法分析浙江大学附属第一医院胃肠甲状腺乳腺外科2011年1月～2012年6月收治的40例行甲状腺全切或近全切除及预防性中央区淋巴结清扫的多灶性甲状腺微小乳头状癌的临床病理学资料及手术相关并发症。结果 40例患者中女性27例,平均年龄46.2岁,原发肿瘤平均直径7mm,25例(62.5%)为双侧微小癌,11例(27.5%)原发肿瘤侵出甲状腺包膜,21例(52.5%)存在中央区淋巴结转移;术后3例(7.5%)出现低钙血症表现,2例(5.0%)出现声音嘶哑,术后3～6个月均恢复正常。结论多灶性甲状腺微小乳头状癌的侵袭性较高,因其有较高的中央区淋巴结转移率,建议行中央区淋巴结清扫。

Objective To find out the clinicopathological characteristics of muhifocal PTMC and the meaning of pro- phylactically central lymph node dissection. Methods The clinicopathological characteristics and postoperative compli- cations of 40 muhifocal PTMCs underwent total or near-total thyroidectomy with prophylactically central lymph node dissection at the department of Gastrointestinal, Thyroid and Breast, the first affiliated Hospital of Zhejiang university from January 2011 to June 2012 were analyzed. Results Among the 40 multifocal PTMCs, 27 cases were female, the mean age was 46.2 years, the mean primary tumor size was 7 mm. 25 cases （62.5%） were bilateral [rFMCs, 11 cases （27.5%） had extrathyroidal invasion of primary tumors. The rate of central lymph metastasis was 52.5% （21 cases）. 3 cas- es （7.5%） developed transient hypocalcemia and 2 cases （5.0%） developed transient hoarseness after operation. Con- clusion Multifocal PTMC is more aggressive. Because of the higher central lymph node metastasis rate, it is necessary to perform central lymph node dissection in multifocal papillary thyroid microcarcinoma.