甲状腺微小乳头状癌的处理

随着超声诊断技术及超声引导下细针穿刺细胞学技术的发展,甲状腺微小乳头状癌(PTMC)的检出率显著增加.目前临床上对PTMC的发生、发展及病理特征尚未明确,至今仍无统一诊治标准.日本等国家建议对某些患者进行密切观察,定期进行超声检查,当肿瘤增大或新出现淋巴结转移时再手术也不迟.欧美国家多主张积极手术治疗,术后远期生存率几乎100％.对于那些具有侵犯甲状腺被膜、有淋巴结转移、多灶、恶性程度高的病理类型等危险因素的PTMC患者,术后给予促甲状腺激素抑制治疗可能会降低局部复发率.在我国,临床上应把握好"度",根据个体化的原则,为不同的患者选择适合自己的最佳治疗方法.

Treatment of papillary thyroid microcarcinoma

The recent development and wide application of ultrasonography and ultrasonography-guided fine needle aspiration biopsy have greatly facilitated the detection of papillary thyroid microcarcinoma (PTMC).Currently, the occurrence, development and pathological features of PTMC are not clearly understood.Therefore, no consensus on the diagnosis and treatment has been reached.Patients with PTMC are suggested to be closely observed and periodically examined with ultrasonography in some countries such as Japan, and these patients are to be operated when the tumor enlarged or new lymphatic metastasis are found.Operation is the first choice in the European and American countries, and the long-term survival rates of these patients are nearly 100％.For the PTMC patients with the risk factors such as thyroid capsule invasion, lymphatic metastasis,multi-focal lesion, higher degree of malignancy, thyroid stimulating hormone suppression therapy was given after operation, which may reduce the local recurrence rate.In China, we should hold well the " limitation" and choose the best way for different patients according to the personalized principle in clinical practice.