甲状腺微小癌107例临床诊疗分析

Clinical diagnosis and treatment of 107 cases of thyroid microcarcinoma

目的探讨甲状腺微小癌的外科治疗方式与预后的关系。方法回顾性分析2013年1～12月107例甲状腺微小癌患者的临床资料，对诊断情况、手术方式、临床病理特征及随访结果进行分析。结果全组患者术前彩超怀疑甲状腺微小癌87例（81.3％）；术前彩超引导下细针穿刺活检95例（88．8％），确诊91例（95．8％）；术中冰冻切片病理确诊103例（96．7％）。107例均经术后病理组织学证实为乳头状癌。107例中行甲状腺全切除20例，患侧及峡部切除＋对侧部分切除69例，患侧切除＋峡部全切除18例;9例行功能性淋巴结清扫，103例行中央区淋巴结清扫。术后颈部淋巴结转移37例（34．6％），其中3例伴有侧颈淋巴结转移。术后随访1年6个月至2年6个月，失访3例;104例患者均存活，发生暂时性喉返神经损伤致声音嘶哑3例（3．0％），无永久性声音嘶哑;暂时性甲状旁腺功能不全8例（7．0％）；术后淋巴漏2例（2．0％）；术后出血再手术2例（2．0％）。其中4例复发，行残余甲状腺全切除术。结论甲状腺微小癌总体预后相对较好，但部分病例有较强的侵袭性、较早出现颈部淋巴结转移，规范化、个体化治疗可进一步提高甲状腺微小癌的治疗效果。

Objective To investigate prognosis and surgical treatment for thyroid microcarcinoma. Methods One hundred-seven patients with thyroid microcarcinoma from January.2013 to December 2013 were enrolled. The clinical data including diagnosis, surgical treatment, clinicopathological characteristics and follow-up results were reviewed. Results There were 87 cases （81.3%） suspected of micocarcinoma by color Doppler ultrasound before operation. Biopsy by fine-needle aspiration guided by color Doppler ultmsotmd were performed in 95 cases （88.8%） before operation, and91 （95.8%） of them were confirmed. There were 103 cases （96.7%） confirmed by frozen section pathological diagnosis during operation. Postoper- ative pathologic diagnosis of 107 cases was papillary carcinoma. Total thyroidectomy was performed in 20 cases, Lobectomy and isthmectomy for tumor side and subtotal lobectomy for another side were performed in 69 cases. Lobectomy and isthmectomy for tumor side were performed in 18 cases. Functional neck dissection was performed in 9 cases. Central district dissection was performed in 103 cases. Postoperative cervical lymph node metastasis were 37 cases （34.6%） , 3 cases with lateral cervical lymph node metastasis. Follow-up was ranged from 1 year and 6 months to 2 years and 6 months, and 3 case lost contact in our survey; 104 patients were alive. Temporary laryngeal recurrent nerve injury induced hoarse occurred in 3 cases （3.0%） . Temporary parathyroid dysfunction were found in 8 cases （7.0%） ; There were 2 cases who got postoperative lymphatic leakage （2.0%） . Postoperative bleeding and reoperation occurred in 2 case （2.0%） . Among them, 4 case was found recurred after surgery and total thyroidectomy was performed then. Conclusion The prognosis of most of thyroid microcarcinoma is satisfied by sut,gical treatment, but partially is aggressive, earlier onset of neck lymph node metastasis. Standardized, individualized treatment should be improved the thempeutic effect of thyroid microcarcinoma.