结节性甲状腺肿合并甲状腺微小癌诊治的探讨

目的探讨结节性甲状腺肿合并微小癌的概率和临床特征,为临床诊治甲状腺微小癌提供依据。方法收集2003年10月至2011年12月广西壮族自治区人民医院术前诊断为结节性甲状腺肿的病例资料2258例,128例术后病理诊断为结节性甲状腺肿合并甲状腺微小癌,统计甲状腺微小癌的概率、术中确诊率、漏诊率、颈部淋巴结转移率、复发率及预后。结果结节性甲状腺肿合并甲状腺微小癌的概率为5.67%(128/2258),术中冰冻病理确诊结节性甲状腺肿合并甲状腺微小癌118例,确诊率为92.19%(118/128),术中甲状腺微小癌的漏诊率为7.81%(10/128),颈部淋巴结转移率为3.90%(5/128),术后复发率为2.34%(3/128)。无因甲状腺微小癌死亡者。结论结节性甲状腺肿合并甲状腺微小癌术前诊断困难,术中仔细探查和快速冰冻切片病理检查有助于提高甲状腺微小癌的诊断率,颈部淋巴结转移率低,不需常规清扫颈部淋巴结。

Diagnosis and Treatment of Nodular Goiter with Coexistent Thyroid Microcarcinoma

Objective To explore the probability and clinical characteristics of nodular goiter with coexistent thyroid microcarcinoma,in order to provide basis for clinical diagnosis and treatment of thyroid microcarcinoma. Methods The clinical data of 2258 patients with preoperative diagnosed nodular goiter from Guangxi Zhuang Autonomous People＇s Hospital was collected, among which 128 patients were postoperatively pathological diagnosed as nodular goiter with thyroid microcarcinoma, and the probability of thyroid microcarcinoma,intraoperative diagnosis rate, missed diagnosis rate, cervical lymph node metastasis rate,recurrence rate and prognosis were statistically analyzed. Results The probability of nodular goiter with coexistent thyroid microcarcinoma was 5.67% （128/2258）, 118 cases were diagnosed by rapid intraoperative frozen pathology, forming an intraoperative diagnosis rate of 92.19% （ 118/128 ）, missed intraoperative diagnosis rate of thyroid microcarcinoma was 7. 81% （ 10/128 ）, cervical lymph node metastasis rate was 3.9% （5/128） ,recurrence rate was 2.34% （3/128）. There was no death because of thyroid microcarcinoma. Conclusion It was difficult to diagnose nodular goiter with coexistent thyroid microcarcinoma preoperatively. The thyroid microcarcinoma diagnostic accuracy rate could be improved by careful intraoperative exploration and rapid frozen section. Cervical lymph node metastasis rate is low, so it is unnecessary to dissect cervical lymph nodes routinely.