34例隐匿性甲状腺癌的临床诊治

目的：探讨隐匿性甲状腺癌的诊断及治疗。方法：回顾性分析34例隐匿性甲状腺癌的临床资料。结果：男性14例，女性20例。年龄24～62岁，平均年龄41．3岁。乳头状癌33例，滤泡状癌1例。单发癌19例，合并甲状腺良性疾病15例。健康体检发现甲状腺肿块占52．9％(18／34)。术前确诊4例，术前疑癌17例。术中快速冰冻病理确诊24例，术后确诊6例。行患侧腺叶 峡部切除11例；患侧腺叶 峡部 对侧腺叶次全切除23例；合并中央区或颈部淋巴结清扫8例。淋巴结转移率17．6％(6／34)，均发生于单一癌灶病例。无术后并发症，平均随访5．8年无肿瘤复发，无颈淋巴结转移和远处转移，无死亡。结论：1)每年健康体检结合B超、同位素、CT、超声引导针吸细胞学检查的综合检查有助于隐匿性甲状腺癌的早期诊断。2)建议治疗选择单侧腺叶 峡部切除或甲状腺次全切除，癌已穿透甲状腺被膜应行颈淋巴结清扫术。常规术中冰冻病理检查，术后服用甲状腺素片。

Diagnosis and Treatment of the Occult Thyroid Carcinomas in 34 Cases

Objective: To investigate the diagnosis and treatment of the occult thyroid carcinoma(OCT). Methods: Clinical data of 34 cases of OCT were restrospectively reviewed. Results: There were 14 men and 20 women with mean age of 41.3(24~62) years old.Among them, 33 patients had papillary carcinoma,1 had follicular carcinoma.Thyroid nodules had been found by annual check-up in 18(52.9%) patients. Only 4 cases were preoperatively diagnosed as OCT.17 were suspected as OCT.24 cases were diagnosed by frozen section.Unilateral thyroidectomy and plus isthmusectomy was performed in 11 patients, subtotal thyroidectomy in 23 patients, pre-and paratracheal and the lateral lymph node resection in 8 patients.Metastasis of cervical lymph nodes were found in 6(17.6%)patients. All patients were followed up for an average of 5.8(1~15)years. No recurrence,no disease related death were found. Conclusion:Ultrasound,nudide,CT, FNAB and annual checkup are helpful for the early diagnosis of OCT. Unilateral lobectomy and isthmusectomy or subtotal thyroidectomy are the treatment of choice, lateral lymph node resection may be helpful when capsular invasion occurred.Frozen section and thyroxin are the therapy of choice routinely.