甲状腺微小乳头状癌的诊治：附47例报告
| 作者: |
1孙永亮,
1杨志英,
1谭海东,
1司爽,
1贾振庚
1 中日友好医院 普通外科，北京 100029 |
| 通讯: |
杨志英
Email: yangzhy@aliyun.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2017.05.005 |
摘要
目的：探讨甲状腺微小乳头状癌（PTMC）的临床病理特征及诊治策略。方法：回顾性分析2011年6月—2016年5月经手术与病理证实的47例PTMC患者临床资料。结果：47例患者中，男9例，女38例；年龄（46.3±12.1）岁；病程（12.4±23.7）个月；均行术前超声检查，14例行超声引导下细针穿刺细胞学检查（FNA），经FNA确诊PTMC 11例（78.6%）；13例行患侧甲状腺全切，3例行患侧甲状腺全切+对侧叶大部切除术，31例行双侧甲状腺全切；14例行中央区颈淋巴结清扫术，15例行中央区加颈侧区淋巴结清扫。肿瘤病灶平均长径（0.68±0.23）cm；21例（44.7%）为多发病灶，其中14例（29.8%）为双侧甲状腺多发病灶；中央区淋巴结转移率48.3%（14/29），颈侧区淋巴结转移率53.3%（8/15）。单因素分析显示，肿瘤侵犯包膜与淋巴结转移有关（P=0.035）。8例患者术后发生并发症，其中暂时性甲状旁腺功能不全5例，切口积液1例，暂时性喉返神经损伤1例，暂时性喉上神经损伤1例。结论：甲状腺外科医生需熟悉甲状腺癌超声特点，不建议扩大FNA指征。对于术前超声已提示多发结节、术中探查可疑多发结节或存在高危因素者，手术建议行双侧甲状腺全切。预防性中央组淋巴结清扫结合术中冷冻病理对确定个体化手术方案及指导术后治疗是必要的。
关键词：
甲状腺肿瘤/诊断
甲状腺肿瘤/治疗
甲状腺切除术
淋巴转移
颈淋巴结清扫术
Diagnosis and treatment of papillary thyroid microcarcinoma: report of 47 cases
CorrespondingAuthor:YANG Zhiying Email: yangzhy@aliyun.com
Abstract
Objective: To investigate the clinical characteristics of papillary thyroid microcarcinoma (PTMC) and its diagnosis and treatment strategies. Methods: The clinical and pathologic data of 47 patients with PTMC that was confirmed by surgical and pathological findings from June 2011 to May 2016 were retrospectively analyzed. Results: Of the 47 patients, 9 cases were male and 38 cases were female, with an average age of (46.3±12.1) years and average disease course of (12.4±23.7) months; all cases underwent preoperative ultrasound examination, and 14 cases underwent ultrasound-guided fine-needle aspiration biopsy (FNA) by which PTMC was diagnosed in 11 cases (78.6%); 13 cases underwent total resection of the affected lobe, 3 cases underwent total resection of affected lobe plus subtotal resection of the contralateral lobe, and 31 cases underwent total thyroidectomy; 14 cases underwent central neck dissection and 15 cases underwent central plus lateral neck dissection. The average axis diameter of the tumors was (0.68±0.23) cm, and 21 patients (44.7%) had multiple lesions, of whom, 14 cases (29.8%) had bilateral thyroid multiple lesions. Twenty-nine patients underwent cervical lymph node dissection and 48.3% (14/29) had central lymph node metastasis. The incidence of lateral lymph node metastasis was 53.3% (8/15). Univariate analysis showed that capsular invasion was significantly associated with lymph node metastasis (P=0.035). Postoperative complications occurred in 8 patients, including transient hypoparathyroidism in 5 cases, and incisional fluid collections and transient recurrent laryngeal nerve injury and superior laryngeal nerve injury in one case each. Conclusion: Thyroid surgeons should be familiar with ultrasound features of thyroid carcinoma, and expansion of the indications to FNA is not recommended. For patients with multiple nodules indicated by preoperative ultrasound or suspected to have multiple nodules during intraoperative exploration, or patients who present with high-risk factors, total thyroidectomy is recommended. Prophylactic central group lymph node dissection with intraoperative frozen pathology diagnosis is essential for surgeons to design a personalized surgical plan and postoperative therapy.
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