甲状腺微小乳头状癌外科治疗争议与共识

Consensus and controversy on surgical treatment of papillary thyroid microcarcinoma

目前,临床对甲状腺微小乳头状癌(PTMC)的处理策略和外科治疗还存在一些争议。在没有"金标准"来区别惰性PTMC和进展性PTMC之前,密切观察的策略不适合我国的国情和医疗环境,不宜过度推广,对诊断明确的PTMC应手术治疗。国内外指南中关于甲状腺的切除范围基本一致,低危病人选择甲状腺腺叶+峡部切除术,中高危病人应行全或近全甲状腺切除术。主张对手术病人至少进行同侧中央区淋巴结清扫,不做预防性颈侧区淋巴结清扫。建议结合能获取的危险因素进行综合评估,并兼顾病人意愿、术者能力,平衡并发症和疾病风险,选择个体化的手术方式。

The therapeutic strategies and choice of operation of papillary thyroid microcarcinoma （PTMC） remain controversial. An active surveillance is not suitable for the actual condition and medical environment in China, which should not be excessively popularized, unless there is a gold standard to distinguish indolent and aggressive PTMC. Surgery is the first choice for PTMC that is diagnosed definitely. Guidelines at home and abroad are essentially the same for the extent of thyroidectomy. Thyroid lobectomy plus isthmectomy is chosen for low-risk patients and total/near totalthyroidectomy should be performed for intermediate- to high-risk patients. It＇ s advocated that at least ipsilateral central-compartment neck dissection should be performed and prophylactic lateral neck compartmental lymph node dissection is not necessary for PTMC. It＇ s recommended that individualized therapy should be chosen by the comprehensive evaluation of the available risk factors and the considerations of the patients＇ preference, the skills of the surgeon, and the balance of complications and the risk of disease.