10例甲状腺滤泡状癌临床诊治分析

Clinical analysis of diagnosis and surgical treatment of 10 patients with follicular thyroid carcinoma

目的探讨甲状腺滤泡状癌(PTC)的超声特点、病理诊断及手术治疗策略。方法收集2013年7月-2017年10月首都医科大学附属北京友谊医院普通外科收治的10例经病理诊断明确的FTC患者资料,其中男3例,女7例,中位年龄41.5岁(15~68岁),对患者的术前超声特点、细针穿刺结果、术中冰冻检查、手术方式等临床资料进行回顾性分析。结果10例患者术前均行超声检查,6例行术中冰冻病理检查,其中5例考虑包膜侵犯。2例患者行患侧颈中央区淋巴结清扫,未发现淋巴结转移。5例行二次手术,手术范围为甲状腺全切/近全除术。10例患者术后均未出现永久性性甲状旁腺功能减退、喉返神经损伤等严重并发症。中位随访时间为34.4个月,随访期间未出现死亡病例。结论FTC术前超声诊断困难,二次手术率明显高于乳头状癌。患侧腺叶+峡部切除术应作为滤泡性肿瘤的初始手术方案,而中央区淋巴结清扫不作为常规推荐。

Objective To investigate the ultrasonographic characteristics,pathological diagnosis and surgical treatment strategy of follicular thyroid carcinoma (FTC).Methods The clinical data of 10 patients with FTC confirmed by histopathology from Jul.2013 to Oct.2017 in Beijing Friendship Hospital,Capital Medical University were retrospectively analyzed including 3 males and 7 females with mean age of 41.5 (15 to 68 )years old.The clinical data including preoperative ultrasonographic features,fine needle aspiration results,intraoperative frozen section examination and surgical treatments of these 10 patients were retrospectively analyzed.Descriptive methods were used for Statistical analysis.Results Ultrasonography was performed in all 10 patients,and frozen section examination was performed in 6 patients,of which,5 were considered capsular invasion.Ipsilateral centralcompartment neck dissection was performed in 2 patients,no node metastasis was found.Reoperation were performed in 5 patients with total or near total thyroidectomy.No severe complications such as persistent hypoparathyroidism and recurrent laryngeal nerve injury occurred in all 10 patients.The median follow-up time was 34.4 months,and no one died during the follow-up period.Conclusions Preoperative diagnosis of FTC is difficult.The reoperation rate is higher than that of papillary thyroid carcinoma.Lobectomy plus isthmusectomy should be the initial surgical procedure for follicular tumors,while neck dissection is not recommended.