本文選題：甲狀腺微小乳頭狀癌　切入點(diǎn)：高分辨率超聲　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：甲狀腺微小乳頭狀癌(Papillary thyroidmicrocarcinoma PTMC)是最大直徑≤10 mm的甲狀腺乳頭狀癌,是甲狀腺癌的一種亞型。近年來(lái),隨著人們健康意識(shí)的提高,以及高分辨率超聲影像檢查等新型輔助診斷方法在臨床上的廣泛應(yīng)用,PTMC的檢出率更是呈現(xiàn)出明顯上升的趨勢(shì)。如今,甲狀腺癌的新增病例中,PTMC的占比已經(jīng)達(dá)到50%以上。PTMC具有臨床癥狀不典型、病情進(jìn)展較為緩慢、體積較小不易檢出等特點(diǎn),臨床上對(duì)于PTMC的早期發(fā)現(xiàn)和診斷還存一定的困難。與此同時(shí),PTMC并非是PTC的早期癌或者癌前病變,有著與PTC相同生物學(xué)特性,存在局部浸潤(rùn)以及頸淋巴轉(zhuǎn)移傾向。但由于絕大多數(shù)PTMC處于亞臨床狀態(tài),發(fā)病隱匿,不影響患者生活質(zhì)量,對(duì)于是否需要立即進(jìn)行手術(shù)治療,以及手術(shù)時(shí)對(duì)于原發(fā)灶的切除范圍和是否需要預(yù)防性的進(jìn)行局部淋巴結(jié)的清掃等方面還存在爭(zhēng)議。隨著診斷技術(shù)的進(jìn)步,高分辨率超聲、CT、MRI等影像學(xué)診斷技術(shù)以及細(xì)針穿刺活檢、術(shù)中冰凍病理等病理診斷技術(shù),在臨床上的應(yīng)用更加廣泛,相應(yīng)的研究也更加完善,診斷的準(zhǔn)確率得到了極大的提升。PTMC治療前的病情評(píng)估及治療預(yù)案的制定也顯得越發(fā)重要。大量的臨床實(shí)踐和研究總結(jié)表明,手術(shù)治療依然是治療甲狀腺微小乳頭狀癌的首選治療方法。傳統(tǒng)的手術(shù)治療方式中,治療甲狀腺微小乳頭狀癌時(shí),甲狀腺的切除范圍主要有兩種,即甲狀腺腺葉+峽部切除和甲狀腺全或近全切除。隨著臨床上的不斷實(shí)踐和總結(jié)改進(jìn),手術(shù)方式的選擇更加細(xì)化、規(guī)范。同時(shí),微創(chuàng)腔鏡技術(shù)得到了廣泛的推廣,新型的手術(shù)治療也將腔鏡技術(shù)應(yīng)用到了甲狀腺疾病的治療領(lǐng)域。目前應(yīng)用比較廣泛的是腔鏡輔助的甲狀腺切除術(shù)即Miccoli術(shù)式和完全腔鏡甲狀腺切除術(shù),兩種手術(shù)方式各有利弊,其適用范圍及技術(shù)細(xì)節(jié)仍在進(jìn)一步完善中。放射碘治療、TSH抑制治療等術(shù)后相關(guān)治療也得到廣泛應(yīng)用,有效性也得到了進(jìn)一步證實(shí)。本文將就甲狀腺微小乳頭狀癌的診斷和外科治療的研究進(jìn)展進(jìn)行綜述。
[Abstract]:Papillary thyroidmicrocarcinoma thyroidmicrocarcinoma is a thyroid papillary carcinoma with a maximum diameter of less than 10 mm and a subtype of thyroid carcinoma. The detection rate of PTMC, as well as new assistant diagnostic methods such as high-resolution ultrasound imaging, has been increasing significantly in clinical practice. Among the new cases of thyroid cancer, the proportion of PTMC has reached more than 50%. PTMC has the characteristics of atypical clinical symptoms, slow progress of the disease, small size, difficult to detect, and so on. It is still difficult to detect and diagnose PTMC clinically. At the same time, it is not an early cancer or precancerous lesion of PTC, and has the same biological characteristics as PTC. There is a tendency of local infiltration and cervical lymphatic metastasis. However, because most of PTMC is in a subclinical state, the onset of the disease is concealed and does not affect the quality of life of the patients. There are still disputes about the scope of primary tumor resection and the need for preventive local lymph node dissection. With the development of diagnostic techniques, imaging diagnostic techniques such as high-resolution ultrasound and CT MRI and fine needle biopsy, Intraoperative frozen pathology and other pathological diagnosis techniques are more widely used in clinical practice, and the corresponding research is more perfect. The accuracy of diagnosis has been greatly improved. PTMC before the treatment of the disease evaluation and treatment planning is increasingly important. A large number of clinical practice and research summary shows that, Surgical treatment is still the first choice for the treatment of thyroid micropapillary carcinoma. Among the traditional surgical treatments, there are two main types of thyroidectomy in the treatment of thyroid micropapillary carcinoma. That is, thyroid gland isthmus resection and total or near total thyroidectomy. With the continuous practice and improvement in clinical practice, the choice of surgical methods is more detailed and standardized. At the same time, minimally invasive endoscopic technique has been widely popularized. The new surgical treatment also applies the endoscopic technique to the treatment of thyroid diseases. At present, endoscopic assisted thyroidectomy (Miccoli) and total endoscopic thyroidectomy (Miccoli) have both advantages and disadvantages. The scope of application and technical details are still being further improved. Radiation iodine therapy, TSH inhibition therapy and other postoperative related treatment are also widely used. This article reviews the diagnosis and surgical treatment of thyroid micropapillary carcinoma.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R736.1

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