甲状腺微小癌的术前诊断及手术方式选择

目的探讨甲状腺微小癌(TMC)的术前诊断及手术方式选择。方法回顾性分析2003年1月—2009年12月在上海市徐汇区中心医院普外科行手术治疗的73例TMC患者的临床资料。结果术前多普勒超声检查高度怀疑为恶性TMC者53例(72.6%)。经术中冰冻切片快速病理检查诊断为甲状腺恶性肿瘤61例,其中51例行患侧甲状腺腺叶+峡部+对侧腺叶次全切除术,术后1例复发;另10例因术前超声检查怀疑颈部淋巴结肿大或(和)病理检查提示包膜受侵犯,行全甲状腺切除术+同侧功能性颈淋巴结清扫术,病理检查淋巴结阳性4例,术后复发1例。经术中冰冻切片快速病理检查诊断为良性甲状腺肿瘤12例,行患侧甲状腺腺叶切除+峡部切除,术后无1例复发。结论 TMC具有特征性的超声表现,术前行常规高频超声检查可提高TMC的术前诊断率。对TMC患者应采用积极的手术治疗,不提倡甲状腺全切除手术,应采用个体化治疗方案。对术前诊断为颈部淋巴结肿大或包膜受侵犯者应行同侧功能性颈淋巴结清扫。

Preoperative diagnosis and surgical treatments of thyroid microcarcinoma

Objective To investigate the preoperative diagnosis and surgical treatment of thyroid microcarcinoma (TMC). Methods From January 2003 to December 2009, 73 TMC patients were treated in our hospital. The clinical data were retrospectively analyzed in this study. Results Fifty-three patients were highly suspected for malignant lesion by preoperative ultrasonograhy. The primary diagnostic rate was 72.60% (53/73). During the surgical treatment, there were 61 TMC cases and 12 benign lesions diagnosed by frozen section. Among the 61 TMC patients, 51 underwent a total thyroid lobectomy on the side with the lesion and the isthmus and a subtotal resection on the opposite lobe. Recurrence occurred in one patient. The other 10 patients were suspected for enlarged cervical lymph nodes by preoperative ultrasonograhy or thyroid capsule involvement by pathology, and received by total lobectomy of bilateral lobes with functional neck lymph node dissection. Four of them were diagnosed as lymph node-positive in postoperative pathology. Recurrence was found in one case during follow-up. The 12 patients with benign lesions received thyroid lobectomy on the side with the lesion and the isthmus, and no recurrence was found. Conclusion TMC has distinctive ultrasonographic characteristics. Routine high-frequency ultrasonographic examination can improve the preoperative diagnosis of TMC significantly. Surgical treatments should be considered while total thyroidectomy is not recommended. Meanwhile, treatments should be individualized. To those cases with enlarged cervical lymph nodes or thyroid capsule involvement during preoperative diagnosis, ipsilateral functional cervical lymph node dissection should be performed.