峡部甲状腺乳头状癌120例临床病理学特征分析

Clinicopathological Features of 120 Cases with Papillary Thyroid Carcinoma in Isthmus

[目的]探讨峡部甲状腺乳头状癌的临床病理学特征,以指导其手术方式的选择。[方法 ]回顾性分析2000年1月至2016年12月浙江省肿瘤医院收治的120例病理证实为峡部甲状腺乳头状癌患者的临床病理学资料。[结果]120例患者中,50例行甲状腺全切术,70例行非甲状腺全切术。74例（61.67%）为微小癌,64例（53.33%）存在多个病灶或腺内播散,75例（62.5%）累及甲状腺被膜,60例（50%）存在颈部淋巴结转移,其中17例（14.17%）为双侧中央区淋巴结转移。31例出现术后暂时性并发症（声嘶、饮水呛咳及低钙）,无患者存在永久性术后并发症。全切组中1例（2%）患者术后脑转移死亡,非全切组中8例（11.43%）发生局部复发或远处转移。[结论]全甲状腺切除术联合双侧中央区颈淋巴结清扫术宜作为峡部甲状腺乳头状癌的常规术式。术中应注意保护双侧喉返神经及甲状旁腺以降低术后并发症的发生率。

[Objective]To analyze the clinicopathological features of papillary thyroid carcinoma locate in the isthmus（PTCI）. [Methods ] The clinical data of 120 patients with pathologically confirmed PTCI admitted in Zhejiang Cancer Hospital from January 2000 to December 2016 were analyzed retrospective. [Results] Of the 120 patients,50 cases underwent total thyroidectomy and70 cases underwent less-than-total thyroidectomy. There were 74 cases（61.67%） of microcarcinoma,64 cases（53.33%） of multiple tumor lesions;75 cases（62.5%） with thyroid capsule involvement,60 cases（50%） with cervical lymph nodes metastasis,17 cases（14.17%） with bilateral central lymph node metastasis. Thirty-one cases had temporary postoperative complications including hoarseness,choking and hypocalcemia,no patients had permanent postoperative complications.One patient（2%） had a brain metastases and died after surgery in the total thyroidectomy group,and 8 patients（11.43%） had local recurrence or distant metastases in the less-than-total thyroidectomy group. [Conclusion] Total thyroidectomy combined with bilateral central lymph node dissection should be used as a regular operation of the PTCI. Attention should be paid to the protection of bilateral recurrent laryngeal nerve and parathyroid gland during the surgery to reduce the incidence of postoperative complications.