专题研究(Monographic Study)

甲状腺微小癌262例临床分析

Published at: 2016年第25卷第11期

王志军 1 , 李玉龙 1 , 彭德峰 1 , 董慧明 1
1 蚌埠医学院第一附属医院 肿瘤外科,安徽 蚌埠 233004
通讯作者 慧明 董 Email: ahbbdong@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.11.006
基金:

摘要

目的:探讨甲状腺微小癌(TMC)的临床特点、诊断及手术方式。方法:回顾性分析2011年1月—2014年6月间经手术及病理证实262例TMC患者的临床资料,并选取90例同期手术治疗的甲状腺良性甲状腺结节(BTN)患者的资料进行对比分析。结果:262例TMC患者中,乳头状癌260例,滤泡状癌1例,未分化癌1例;术中冷冻切片确诊246例(93.9%);合并结节性甲状腺肿126例(48.09%),甲状腺腺瘤18例(6.87%),慢性淋巴细胞性甲状腺炎27例(10.30%),甲状腺功能亢进3例(1.15%)。与BTN患者比较,TMC患者超声显示低回声、沙砾样钙化、血流信号丰富、高TI-RADS分级的比率明显高于BTN组(均P<0.05);高分辨超声对TMC诊断的灵敏度、特异度、阳性预测值、阴性预测值分别为83.88%、80.50%、91.73%、65.97%。所有患者均行手术治疗,包括患侧腺叶+峡部切除术73例,患侧腺叶+峡部+对侧次全切除术153例,全甲状腺切除术36例。172例进行了淋巴结清扫,其中中央区淋巴结清扫术162例,有45例(27.78%)出现了淋巴结转移,功能性颈清扫术10例均出现淋巴结转移。TMC患者中央区淋巴结转移与肿瘤最大直径、癌灶数目有关(χ2=6.77、13.11,均P<0.05);行与未行中央区淋巴结清扫术后并发症发生率差异无计学意义(χ2=0.09,P>0.05);不同手术方式患者术后复发率差异无统计学意义(χ2=2.89,P>0.05)。结论:TMC以乳头状癌为主,高分辨超声是诊断TMC的重要方法。TMC患者应根据病灶数目、大小在腺叶+峡叶切除和全/近全甲状腺切除术中合理选择术式,同时常规行同侧中央区淋巴结清扫,高度怀疑或明确有颈侧区淋巴结转移患者加做功能性颈部淋巴结清扫。


Thyroid microcarcinoma: a clinical analysis of 262 cases

Abstract

Objective: To investigate the clinical characteristics, diagnosis and surgical procedure for thyroid microcarcinoma (TMC). Methods: The clinical data of 262 TMC patients confirmed by surgical and pathological findings from January 2011 to June 2014 were reviewed, and were comparatively analyzed with the data of 90 patients with benign thyroid nodules (BTN) undergoing surgery during the same period. Results: Of the 262 TMC patients, 260 cases had papillary carcinoma, 1 case had follicular carcinoma, and 1 case had undifferentiated carcinoma; 246 cases (93.9%) were diagnosed as TMC by intraoperative frozen section; 126 cases (48.09%) were combined with nodular goiter, 18 cases (6.87%) with thyroid adenoma, 27 cases (10.30%) with chronic lymphocytic thyroiditis, and 3 cases (1.15%) with hyperthyroidism. The proportions of low echo, micro calcification, abundant blood flow signal, high TI-RADS grade shown by ultrasound examination in TMC patients were significantly higher than those in BTN patients (all P<0.05), and the sensitivity, specificity, positive predictive value and negative predictive value of high resolution ultrasound for diagnosis of TMC was 83.88%, 80.50%, 91.73% and 65.97% respectively. All TMC patients received surgical treatment that included ipsilateral thyroidectomy plus isthmectomy in 73 cases, subtotal thyroidectomy in 153 cases and total thyroidectomy in 36 cases. One hundred and seventy-two patients underwent lymph node dissection that included central lymph node dissection in 162 cases, and metastasis was found in 45 cases (27.78%) and was found in all the 10 cases who accepted additional functional neck dissection. The central cervical lymph node metastasis in TMC patients was significantly associated with tumor size and number of lesions (χ2=6.77 and 13.11, both P<0.05); the incidence of postoperative complications showed no statistical difference between patients with and without central lymph node dissection (χ2=0.09, P>0.05); no statistical difference was noted in postoperative recurrence rate among patients undergoing different surgical procedures (χ2=2.89, P>0.05). Conclusion: Papillary carcinoma is the main type of TMC and high-resolution ultrasonography is an important diagnostic method for TMC. In TMC patients, proper procedure of ipsilateral thyroidectomy plus isthmectomy or total/subtotal thyroidectomy should be selected according to tumor number and size, and routine ipsilateral central lymph node dissection should be performed, while additional functional neck dissection should be performed in those with highly suspicious or confirmed lateral cervical lymph node metastases.


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引用

引用本文: 志军 王, 玉龙 李, 德峰 彭, 慧明 董. 甲状腺微小癌262例临床分析[J]. 中国普通外科杂志, 2016, 25(11): 1557-1562.
Cite this article as: WANG Zhijun, LI Yulong, PENG Defeng, DONG Huiming . Thyroid microcarcinoma: a clinical analysis of 262 cases [J]. Chin J Gen Surg, 2016, 25(11): 1557-1562.