甲状腺微小乳头状癌的诊断与治疗

Diagnosis and treatment for small papillary thyroid cancers

目的 探讨甲状腺微小乳头状癌（PTMC）的诊断和外科治疗方法.方法 回顾性分析2008年1月至2012年12月我院收治的138例PTMC患者诊断和治疗的临床资料.结果 138例患者术前均无临床不适症状,为查体时超声波检查所发现.所有病例甲状腺超声显示结节直径≤1.0 cm,结节内有钙化122例,血流丰富84例,边界不清53例.其中术前通过甲状腺结节细针穿刺和细胞学检查54例,明确为微小癌46例,假阴性8例.其余均为术后病理证实.所有病例中单侧单发甲状腺微小癌96例,单侧多发甲状腺微小癌20例,双侧多发甲状腺微小癌22例.采用患侧＋峡部切除＋对侧腺叶次全切除64例;患侧＋峡部腺叶切除35例;双侧甲状腺切除18例;双侧甲状腺次全切除25例.行颈部淋巴结清扫76例,未行颈部淋巴结清扫62例.其中合并淋巴结转移26例,无淋巴结转移112例.术后随访1～6年,出现喉返神经损伤4例,喉上神经损伤2例,一过性甲状旁腺损伤2例.局部复发4例,无远处转移和死亡病例.结论 甲状腺高频超声波检查是发现PTMC的重要手段.术前甲状腺结节细针穿刺和细胞学检查是及时判定结节性质的最可靠方法.手术是治疗PTMC的最佳治疗方式.而选择合理的手术方式是提升治疗效果、较少并发症的关键.

Objective To investigate the diagnosis and surgical intervention for small papillary thyroid microcarnoma（PTMC）. Methods A retrospective study was conducted. One hundred and thirty-eight patients with small PTMC were enroll in this study who were hospitalized from Jan. 2008 to Dec. 2012 in the No. 309th Hospital of Chinese People Liberation of Army. Results All of the 138 patients have no clinical was diagnosed by thyroid ultrasound symptoms before operation,which exhibited very small nodules （≤ 1 cm）. Among the 138 cases, 122 cases has calcified thyroid nodules and 88 cases showed rich blood flow in nodules as well as 53 cases the boundary was not clear. Pre-operation,54 cases were implemented by fine needle aspiration（FNA）. Among 54 cases, 46 cases were diagnosed as small papillary thyroid cancers and 8 cases were not diagnosed by FNA. The remaining was proved by postoperative pathological examination. All of these 138 cases,96 cases were unilateral and solitary, 20 cases were solitary and multiple, and the remained 22 cases were multiple unilateral. Sixty-four cases were operated by side lobe resection plus isthmus resection and contralateral subtotal resection,35 cases were operated by side lobe resection plus isthmus resection, 18 cases were operated by bilateral thyroid resection and 25 cases were operated by bilateral thyroid subtotal resection. Seventy-six cases were operated with cervical lymph node dissection and the remaining 62 cases were not. Twenty-six cases have lymph node metastasis and the remained 112 were not. In the postoperative period （1 -6 years ）, there were 4 cases of recurrent laryngeal nerve injury, 2 cases of laryngeal nerve injury and 2 cases with transit parathyroid gland injury. During the postoperative period, there were 4 cases with local recurrence and no distant metastases and dead. Conclusion High-intensity focused ultrasound is an important method for diagnosis the small papillary thyroid cancers. FNA is the most reliable method to preoperative determination of the nature of the thyroid nodule. Meanwhile, the reasonable and effective surgery is the key to optimize the therapeutic effect and reduce side-effects.