甲状腺微小癌临床特点及手术方式的探讨

Research of the clinical character and reasonable operation of thyroid microcarcinoma(TMC)

目的探讨甲状腺微小癌的临床特点和合理的手术方式。方法对168例甲状腺微小癌进行回顾性分析。结果 168例甲状腺微小癌,单发病灶124例（73.8%）,多发灶44例（26.2%）。预防性中央区淋巴结清除术68例,中央区淋巴结转移率44.1%（30/68）。中央区淋巴结转移行同侧III、IV区淋巴结清除术9例,颈侧区淋巴结转移率77.8%（7/9）。全组病人无声音嘶哑发生,暂时性甲状旁腺损伤发生率23.8%（40/168）,术后出血1例。预防性中央区淋巴结清除术术后并发症发生率35.3%（24/68）高于未行中央区淋巴结清除术17.6%（13/74）。在84例行中央区淋巴结清除和改良式淋巴结清除术中,男性组颈部淋巴结转移率84.6%（11/13）高于女性47.9%（34/71）,多灶甲状腺微小癌颈淋巴结转移率65.4%（17/26）高于单灶48.3%（28/58）。门诊随诊12~36个月无局部复发及远处转移发生。结论甲状腺微小癌具有多灶性和中央区淋巴结高转移率的特点,预防性中央区淋巴结清除术是必要的,特别是对于男性、多灶性、有包膜侵犯者。如中央区淋巴结查见转移癌建议行同侧III、IV区淋巴结清除术或功能性淋巴结清除术。

Objective To research the clinical character and reasonable operation of thyroid microcarcinoma（ TMC）. Methods 168 patients of TMC were retrospective. Results Within 168 TMC,single lesion was found in 124 patients（ 73. 8%）,multifocality lesions in 44 patients（ 26. 1%）. The ratio of central lymph node metastasis was 44. 1%（ 30 /68） in the 68 patients of prophylactic central lymph node dissection.9 patients suffered regional lymph nodes dissection（ level III and IV compartment）. The ratio of unilateral lymph node metastasis was 77. 8%（ 7 /9） in this subgruop. All patients did not show vocal cord paralysis. The ratio of temporary parathyroid injury was 23. 8%（ 40 /168）,1 patient bleeding after operation. The complications of near-total thyroidectomy and prophylactic central lymph node dissection were higher than patients only suffered near-total thyroidectomy（ P〈 0. 001）. Within 84 patients of CLN dissection and modified radical neck dissection,the ratio of neck lymph node metastasis of male patients（ 84. 6%） was higher than female patients（ 47. 9%）（ P 〈0. 001）. The ratio of neck lymph node metastasis of multifocality lesions（ 65. 4%） was higher than single lesion（ 48. 3%）（ P〈 0. 001）. No recurrence and distant metastasis occurred during follow-up from 12 to 36 months after operations. Conclusion TMC showed a high incidence of multifocality and central lymph node metastasis. Prophylactic central lymph node dissection is necessary for TMC,especially for male gender,tumor multifocality,and extrathyroidal extension. These findings suggested regional lymph nodes dissection or functional unilateral neck dissection when central lymph node metastasis.