發(fā)布時(shí)間：2018-08-20 07:49

【摘要】：目的:探討甲狀腺微小乳頭狀癌(PTMC)的臨床病理特征及診治策略。方法:回顧性分析2011年6月—2016年5月經(jīng)手術(shù)與病理證實(shí)的47例PTMC患者臨床資料。結(jié)果:47例患者中,男9例,女38例;年齡(46.3±12.1)歲;病程(12.4±23.7)個(gè)月;均行術(shù)前超聲檢查,14例行超聲引導(dǎo)下細(xì)針穿刺細(xì)胞學(xué)檢查(FNA),經(jīng)FNA確診PTMC 11例(78.6%);13例行患側(cè)甲狀腺全切,3例行患側(cè)甲狀腺全切+對(duì)側(cè)葉大部切除術(shù),31例行雙側(cè)甲狀腺全切;14例行中央?yún)^(qū)頸淋巴結(jié)清掃術(shù),15例行中央?yún)^(qū)加頸側(cè)區(qū)淋巴結(jié)清掃。腫瘤病灶平均長徑(0.68±0.23)cm;21例(44.7%)為多發(fā)病灶,其中14例(29.8%)為雙側(cè)甲狀腺多發(fā)病灶;中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移率48.3%(14/29),頸側(cè)區(qū)淋巴結(jié)轉(zhuǎn)移率53.3%(8/15)。單因素分析顯示,腫瘤侵犯包膜與淋巴結(jié)轉(zhuǎn)移有關(guān)(P=0.035)。8例患者術(shù)后發(fā)生并發(fā)癥,其中暫時(shí)性甲狀旁腺功能不全5例,切口積液1例,暫時(shí)性喉返神經(jīng)損傷1例,暫時(shí)性喉上神經(jīng)損傷1例。結(jié)論:甲狀腺外科醫(yī)生需熟悉甲狀腺癌超聲特點(diǎn),不建議擴(kuò)大FNA指征。對(duì)于術(shù)前超聲已提示多發(fā)結(jié)節(jié)、術(shù)中探查可疑多發(fā)結(jié)節(jié)或存在高危因素者,手術(shù)建議行雙側(cè)甲狀腺全切。預(yù)防性中央組淋巴結(jié)清掃結(jié)合術(shù)中冷凍病理對(duì)確定個(gè)體化手術(shù)方案及指導(dǎo)術(shù)后治療是必要的。
[Abstract]:Objective: to investigate the clinicopathological features, diagnosis and treatment of (PTMC) in thyroid micropapillary carcinoma. Methods: the clinical data of 47 patients with PTMC confirmed by operation and pathology from June 2011 to May 2016 were analyzed retrospectively. Results among 47 patients, 9 were male and 38 were female, the age was (46.3 鹵12.1) years, the course of disease was (12.4 鹵23.7) months. All patients underwent ultrasound examination before operation and 14 cases underwent ultrasound guided fine needle aspiration cytology (FNA),). 11 cases (78.6%) of PTMC were confirmed by FNA. 13 cases (78.6%) underwent total thyroidectomy on the affected side. 3 cases were treated with total thyroidectomy and 31 cases with bilateral thyroidectomy. 14 cases underwent central neck lymph node dissection and 15 cases underwent central and lateral neck lymph node dissection. The mean long diameter of tumor was (0.68 鹵0.23) cm ~ (-1) in 21 cases (44.7%), in which 14 cases (29.8%) were multiple thyroid lesions, the lymph node metastasis rate in the central region was 48.3% (14 / 29), the lymph node metastasis rate in the cervical region was 53.3% (8 / 15). Univariate analysis showed that tumor invasion and capsule involvement were associated with lymph node metastasis in 8 patients with postoperative complications, including temporary parathyroid dysfunction in 5 cases, incisional effusion in 1 case, and temporary recurrent laryngeal nerve injury in 1 case. Temporary superior laryngeal nerve injury in 1 case. Conclusion: thyroid surgeons should be familiar with the ultrasonic features of thyroid cancer and should not extend FNA indications. Bilateral total thyroidectomy is recommended for those with multiple nodules identified by ultrasound before operation, suspicious multiple nodules or high risk factors during operation. Preventive central group lymph node dissection combined with intraoperative cryopreservation is necessary to determine individual operation plan and guide postoperative treatment.
【作者單位】： 中日友好醫(yī)院普通外科;
【分類號(hào)】：R736.1

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