摘要
目的：探讨甲状腺微小癌（thyroid microcarcinoma，TMC）的临床特点、诊断和治疗。方法：回顾分析手术治疗的51例TCM发病、临床、病理特点和术前、术中诊断及治疗方法。结果：TCM占同期收治的甲状腺癌的29、0％。19．6％的患者为多发性。临床主要表现为甲状腺结节性肿大，健康查体B超检查发现15例。45例（88．2％）术前B超检查提示可疑甲状腺癌。术中常规行快速病理检查，主要术式为腺叶、峡部和对侧腺叶大部切除，术中探查Ⅵ、Ⅳ、Ⅲ组淋巴结并做快速冷冻病理检查，有淋巴结转移的16例行功能性颈淋巴结清除。病理检查确诊TMC37．3％有淋巴结转移，74．5％的患者伴有结节性甲状腺肿，27．5％伴有慢性淋巴性甲状腺炎，仅4例为单纯甲状腺癌。全部患者均随访2～74个月，均无瘤生存。结论：TMC发病率较高，多伴有常见的良性甲状腺结节性病变，多数患者预后好。注重术前超声检查和术中全面探查及快速病理检查有助于TMC的诊断。酌情选择恰当的术式，既清除病灶又避免不必要的过度治疗。
OBJECTIVE： To investigate the clinical characteristics, diagnosis and treatment of thyroid mieroeareinoma （TMC）. METHODS： The morbility, clinical and pathological characteristics, pre-operative and intraoperative diagnoses and treatments of 51 patients with TMC were analyzed retrospectively, RESULTS： The sum of TMC occupied 29.0% of all the thyroid carcinomas within the same period, and 19.6% tumors were multiple and manifestated nodular mass clinically. Fifteen cases were found node in thyroid by screening, and 45 cases （88.2%） were indicated as doubtful thyroid carcinoma by pre-operative B ultrasonography. All the cases were examinated routinely by the frozen section method in operation, and the main operation type was total resection of lobe, isthmus and subtotal resection of contralateral lobe. Ⅵ,Ⅳ,Ⅲ lymphonodes were explored and detected by the frozen section, and radical neck dissection was performed on 16 cases with lymphonods metastasis, and 37.3 % TMC with lymphatic metastasis was proved by pathology, 74.5% cases were accompanied with nodular goiter and 27.5% with Hashimotos thyroiditis, 4 cases with thyroid carcinoma only. All patients were followed up from 2 to 74 months, and well alive without tumor. CONCLUSIONS： TMC has high morbility and accompanies common benign thyroid nodular mass, and most patients with TMC have good prognoses. Those methods of preoperative ultrasonography, thorough exploration and frozen section during operation help to diagnose TMC, and pertinent operation type can eliminate tumors and avoid unnecessary excess treatment.
出处
《中华肿瘤防治杂志》
CAS
2007年第19期1480-1482,共3页
Chinese Journal of Cancer Prevention and Treatment
关键词
癌
小细胞/外科学
癌
小细胞/诊断
甲状腺肿瘤/病理学
预后
carcinoma, small cell/surgery
carcinoma, small cell/diagnosis
thyroid neophasms/pathology
prognosis
作者简介
[通讯作者]范西红，女，河南新县人，主任医师，主要从事乳腺、甲状腺、胃肠肿瘤的临床研究工作。Tel：86-531-51666479 E-mail：fxh1023@yahoo．com．cn
