甲状腺微小乳头状癌风险度分级及术式选择的探讨148例

Discussion on risk classification and surgical selection in papillary thyroid microcarcinoma:analysis of 148 cases

目的探讨甲状腺微小乳头状癌(PTMC)的风险度分级,并提供选择适宜术式的参考依据。方法回顾性分析空军特色医学中心普通外科2019.12~2022.12期间手术的148例经病理证实的PTMC患者的临床资料。总结术前超声、手术方式、术中和术后病理结果,综合分析后得出PTMC风险度分级标准,并指导术式选择。结果148例PTMC患者淋巴结转移率40.5%,77例单发PTMC组19.5%,71例多发PTMC组为63.4%,差异具有统计学意义。术前超声诊断颈部淋巴结转移的准确率为75.0%、敏感度84.9%,多发PTMC的准确率为80.3%。以术前超声和术中冰冻病理结果将入组病例分为低风险组和高风险组,61例低风险组PTMC患者的淋巴结转移率为4.9%,87例高风险组为65.5%,差异具有统计学意义。结论术前高质量的超声检查和术中冰冻病理可以作为术式选择的重要指导指标。以此分类的低风险组行甲状腺腺叶+峡部切除和高风险组行甲状腺全切+患侧区域淋巴结清扫是适宜的。

Objective To explore the risk classification of papillary thyroid microcarcinoma(PTMC),and to provide reference for selecting the appropriate surgical method.Methods The clinical data of 148 PTMC patients admitted to our department from December 2019 to December 2022 were retrospectively analyzed.The results of preoperative ultrasonography,surgical methods,and intraoperative and postoperative pathological reports were summarized to obtain the risk classification of PTMC to select the appropriate surgical method.Results The rate of lymph node metastasis was 40.5%in the total 148 PTMC patients,19.5%in the 77 patients with single PTMC,and 63.4%in the 71 patients with multiple PTMC;the difference between the latter two groups was statistically significant.The accuracy and sensitivity of preoperative ultrasonography for diagnosing neck lymph node metastasis were 75.0%and 84.9%,respectively,and the accuracy for diagnosing multiple PTMC was 80.3%.We used preoperative ultrasonography and intraoperative frozen pathology as the classification indicators.The rate of lymph node metastasis was 4.9%in 61 low-risk PTMC patients,and 65.5%in 87 high-risk PTMC patients;the difference was statistically significant.Conclusion High-quality preoperative ultrasonography and accurate intraoperative frozen pathology can provide reliable information for the selection of appropriate surgical procedure.According to this classification,it is appropriate to perform thyroid lobe+isthmus resection in the low-risk group and total thyroid resection+affected lymph node dissection in the high-risk group.