甲状腺单侧微小乳头状癌的手术治疗

Surgical treatment for unilateral papillary thyroid microcarcinoma

目的探讨适合甲状腺单侧微小乳头状癌的手术方式。方法回顾性分析1999年1月至2007年12月中国医学科学院肿瘤医院头颈外科治疗的323例甲状腺单侧微小乳头状癌的资料，分析预后的影响因素。结果323例甲状腺单侧微小乳头状癌10年累积总体生存率为95．3％，疾病特异性生存率为98．9％，无复发生存率为85．5％。10年累积残叶复发率为6．5％。被膜侵犯、pT分期和临床分期是复发的危险因素（均P〈0．05）。Cox多因素分析显示pT分期是独立的危险因素（HR2．153，95％CI 1．231—3．767，P=0．007）。311例非全甲状腺切除的患者，10年累积残叶复发率为6．8％（13例）。结论甲状腺单侧微小乳头状癌预后良好，患侧腺叶及峡部切除是合适的手术方式，腺体外侵犯是其复发高危因素。

Objective To investigate the appropriate surgical procedure for unilateral papillary thyroid microcarcinoma （PTMC）. Methods Clinical data of 323 patients with unilateral PTMC in Cancer Hospital of Chinese Academy of Medical Sciences from 1999 - 2007 were retrospectively studied. Survival outcomes and prognostic factors were analyzed. Results After a median follow-up of 102 （range, 12 - 188） months, the 10-year overall and disease-specific survival was 95.3% and 98. 9%. The 10-year recurrence-free survival was 85.5%. The 10-year cumulative recurrence rate of residue glands was 6. 5%. Capsular invasion, pT stage and clinical stage were significant predictive factors for recurrence of residue glands （ all P 〈 0.05 ）. Cox regression multivariate analysis showed that pT stage （ HR 2. 153, 95% CI l. 231 -3. 767, P = 0. 007 ） was independent predictive factor. Of the 311 patients treated with non-total thyroidectomy, the 10-year cumulative recurrence rate of residue glands was 6. 8% Conclusions Unilateral PTMC has a good prognosis and hemithyroidectomy （ lobectomy and isthmuseetomy） is an appropriate surgical pattern. Extrathyroidal extension is a significant predictor for recurrence.