甲状腺滤泡状癌的诊断和外科治疗

Current status of diagnosis and surgical treatment for follicular thyroid carcinoma

目的探讨甲状腺滤泡状癌的诊断和外科治疗的现状。方法回顾性分析浙江大学医学院附属第一医院1997-2006年诊治的66例甲状腺滤泡状癌患者的临床资料,采用Kaplan-Meier法计算患者的累积生存率和无疾病生存率。结果 66例患者中,63例行术中冰冻切片检查,诊断为甲状腺滤泡状癌46例,诊断率为73.0%(46/63)。术后病理学检查诊断为甲状腺微小浸润型滤泡状癌的19例患者中,术中冰冻切片检查明确诊断11例,诊断率仅为11/19。16例患者行颈部淋巴结清扫,术后病理学检查证实所有淋巴结均为阴性。42例患者获得术后随访,中位随访时间为68个月。随访结果显示,2例患者(4.8%,2/42)发生局部复发;3例患者(7.1%,3/42)发生肺部转移,均于随访期内死亡。患者术后1、2、3、5、10年的累积生存率分别为100.0%、97.5%、94.9%、91.7%、91.7%,无疾病生存率分别为92.7%、90.2%、90.2%、87.2%、87.2%。结论术中冰冻切片检查诊断甲状腺滤泡状癌存在难度,其淋巴结转移率极低,远处转移率较高,甲状腺全切除术可作为外科初始治疗的推荐术式。

Objective To investigate current diagnosis and surgical treatment of follicular thyroid carcinoma. Methods The clinical data of 66 patients with follicular thyroid carcinoma treated between 1997 and 2006 in our hospital were retrospectively analyzed. Statistical analysis was performed by using IBM SPSS Statistics 18.0. Kaplan-Meier test was used to calculate cumulative survival rate and disease-free survival rate. Results Intraoperative frozen section was performed in 63 patients and follicular thyroid carcinoma was confirmed in 46 patients （73.0 %, 46/63）. There were 19 patients with microinvasive follicular thyroid carcinoma confirmed by postoperative pathological analysis; of them, 11 patients （11/19） were diagnosed by frozen section. Sixteen patients received cervical lymph node dissection, and pathological diagnosis was negative for all lymph nodes. During a median follow-up of 68 months in 42 patients, regional recurrence occurred in 2 patients （4.8%, 2/42/ and pulmonary metastasis happened in 3 patients （7. 1%, 3/42）, and they all died of the disease eventually. According to Kaplan-Meier test, the 1, 2, 3, 5 and 10-year cumulative survival rates were 100.0%, 97.5%, 94.9%, 91.7% and 91.7%; the 1, 2, 3, 5 and 10-year disease-free survival rates were 92.7%, 90.2%, 90.2%, 87. 2%, and 87. 2%, respectively. Conclusion It is very difficult to diagnose follicular thyroid carcinoma by intraoperative frozen section. Follicular thyroid carcinoma has a very low lymph node metastasis rate as compared with the high rate of distant metastasis. Total thyroidectomy should be recommended for initial surgical therapy.