甲状腺微小癌110例临床漏诊原因及对策

目的 探讨甲状腺微小癌临床漏诊原因及对策。方法 分析1985年１月到2000年12月经手术和病理证实的甲状腺微小癌110例的诊断和治疗资料。结果 术前拟诊26例，B超诊断阳性率58%(15/26)，术中冰冻诊断阳性率67%(14/21)。术中拟诊30例，冰冻切片诊断阳性率80%(24/30)。术后病理检查确诊微小癌54例，其中19例术中冰冻未发现微小癌。仅35例行全甲状腺或次全甲状腺切除，其余行一侧叶或双侧叶的甲状腺切除术。随访率80.1%，随访时间６月至15年。１例复发，无一例死亡。结论 甲状腺微小癌临床漏诊率较高。术前仔细的触诊，B超结合细针穿刺抽吸细胞学检查（FNAC）和术中认真探查可疑结节有助于提高临床诊断率。甲状腺叶的全切除或次全切除治疗甲状腺微小癌具有良好的临床疗效。     

甲状腺多发结节合并甲状腺微小癌19例临床分析

目的探讨甲状腺多发结节合并甲状腺微小癌的临床特点及诊治方法,以提高甲状腺微小癌的诊治水平。方法 2011-04—2015-04,共手术治疗201例甲状腺多发结节,其中19例(9.45%)经术后常规病理检查证实合并甲状腺微小癌。对患者的临床资料进行回顾性分析。结果 19例患者中术前彩超检查拟诊14例,诊断符合率为73.68%,术中快速冰冻切片病理学检查确诊18例,诊断符合率为94.74%。乳头状腺癌16例,滤泡状腺癌3例。术后根据甲功检查服用优甲乐片,随访1~4 a,无复发病例。结论甲状腺微小癌缺乏典型临床表现,术前彩超及弹性成像检查、术中快速冰冻病理学检查和术后常规病理学检查是诊断甲状腺微小癌的有效措施。若术前彩超扫查未发现患侧颈淋巴结转移者,行患侧腺叶、峡部及对侧腺部分切除即可,不需做预防性颈淋巴结清扫。但术后应根据甲状腺功能检查结果服用优甲乐片等治疗。     

甲状腺微小癌诊断和治疗：附52例报告

目的分析甲状腺微小癌的临床特征,并探讨其诊断及手术治疗方法。方法回顾性分析分析2003—2008年经手术和病理证实的52例甲状腺微小癌临床资料。结果术后病理检查确诊甲状腺微小癌52例,其中术中冷冻切片发现30例,准确率57．7％,末发现22例。术前B超检查48例为实质性结节（92．31％）,边界不清楚,4例为含液性病灶,19例（35．19％）有细砂粒样钙化;B超术前诊断甲状腺癌11例。38例行忠侧甲状腺叶切除加对侧甲状腺次全切除,3例双侧甲状腺全切除术,3例行双侧甲状腺次全切除,患侧全切除5例,3例加行一侧改良性颈部淋巴结清扫。27例cN1行中央组淋巴结清扫,转移半11／27（40．74％）,其余25例cN0未探及中央组淋巴结而未行清扫。随访率96．2％,随访时间3个月至5年,无1例复发及死亡。结论（1）术前B超为首选检查。（2）对甲状腺微小癌,主张行患侧腺叶全切加峡部切除及对侧腺叶次全切除,并行中央组淋巴结清扫。     

原发性甲状腺功能亢进合并甲状腺癌的诊治

目的探讨原发性甲状腺功能亢进合并甲状腺癌的诊治方法及效果。方法原发性甲亢合并甲状腺癌15例,占同期手术治疗的原发性甲亢病例的4.1%(15/366)。术前经B超及细针穿刺细胞学检查确诊4例。行甲状腺全切术3例(其中1例合并颈部淋巴结肿大,行颈部淋巴结清扫术),另1例行患侧腺体+峡部切除并对侧腺体大部分切除。9例术中快速冰冻切片确诊,为甲亢并甲状腺微小癌,均行患侧腺体+峡部切除并对侧腺体大部分切除。2例仅行双侧甲状腺次全切除但术后病理发现癌变的患者,1例因是髓样癌在5 d内再次行患侧残留腺体切除术,另1例因是乳头状微小癌而未再行手术。结果随访12例,时间平均为5.3(1个月~14年),其中1例术后病理证实为滤泡状癌者术后1年内复发,再次行甲状腺全切除+颈部淋巴结清扫术,并加行放疗,目前仍存活,其余患者均无复发,存活至今。结论对某些特殊类型的甲亢患者应警惕癌变的可能,尽量在术前、术中确诊。甲亢合并的甲状腺癌预后较好,手术多以患侧全切+对侧次全切为主。     

甲状腺微小乳头状癌的诊治：附47例报告

目的:探讨甲状腺微小乳头状癌(PTMC)的临床病理特征及诊治策略。方法:回顾性分析2011年6月—2016年5月经手术与病理证实的47例PTMC患者临床资料。结果:47例患者中,男9例,女38例;年龄(46.3±12.1)岁;病程(12.4±23.7)个月;均行术前超声检查,14例行超声引导下细针穿刺细胞学检查(FNA),经FNA确诊PTMC 11例(78.6%);13例行患侧甲状腺全切,3例行患侧甲状腺全切+对侧叶大部切除术,31例行双侧甲状腺全切;14例行中央区颈淋巴结清扫术,15例行中央区加颈侧区淋巴结清扫。肿瘤病灶平均长径(0.68±0.23)cm;21例(44.7%)为多发病灶,其中14例(29.8%)为双侧甲状腺多发病灶;中央区淋巴结转移率48.3%(14/29),颈侧区淋巴结转移率53.3%(8/15)。单因素分析显示,肿瘤侵犯包膜与淋巴结转移有关(P=0.035)。8例患者术后发生并发症,其中暂时性甲状旁腺功能不全5例,切口积液1例,暂时性喉返神经损伤1例,暂时性喉上神经损伤1例。结论:甲状腺外科医生需熟悉甲状腺癌超声特点,不建议扩大FNA指征。对于术前超声已提示多发结节、术中探查可疑多发结节或存在高危因素者,手术建议行双侧甲状腺全切。预防性中央组淋巴结清扫结合术中冷冻病理对确定个体化手术方案及指导术后治疗是必要的。     

甲状腺峡部乳头状癌手术切除范围探讨

目的 探讨甲状腺峡部乳头状癌手术切除的范围。方法 回顾性分析上海交通大学医学院附属瑞金医院和远洋分院自2007年1月至2011年12月收治的28例甲状腺峡部乳头状癌的临床资料。结果 28例中20例（71.43%）双侧中央区淋巴结均发现转移,8例（28.57%）双侧中央区淋巴结未发现转移。13例术前伴双侧甲状腺多发结节者,9例结节性甲状腺肿,4例慢性淋巴细胞性甲状腺炎伴结节性甲状腺肿,其中1例发现微小癌。3例术前伴一侧多发结节者,为结节性甲状腺肿。术后有3例出现暂时性声嘶,7例发生暂时性低钙血症。结论　甲状腺峡部乳头状癌行双侧中央区淋巴结清扫是必要的;对伴双侧甲状腺多发结节者,同时行甲状腺全切除术;但对仅峡部单发癌结节或一侧腺叶多发结节者,行双侧甲状腺次全切或结节侧腺叶切除及对侧无结节侧腺叶次全切,以减少术后并发症。     

原发性甲状腺机能亢进症合并甲状腺癌临床分析

目的：探讨原发性甲状腺机能亢进症（Graves病,甲亢）合并甲状腺癌的临床特点、误诊原因和诊治方法。 方法：回顾性分析1998年1月—2012年2月收治的12例患者的临床表现特点及诊断治疗过程。 结果：全组甲亢合并甲癌发病率4.08%（12/294）,中位年龄36.5岁;3例行患侧叶切除加对侧叶大部分切除术,9例行全甲状腺切除术（其中5例为二次手术）,4例VI区淋巴结清扫均为（-）,无神经损伤,1例造成永久性甲状旁腺功能低下。2例失访, 10例5年生存率100%。 结论：甲亢合并甲癌发病年龄较轻,转移少,多发微小病灶,行患侧叶切除加对侧叶大部分切除术或全甲状腺切除术预后好。术中需常规行快速冷冻病理检查。     

甲状腺功能亢进合并甲状腺微小癌的外科诊治分析

目的　探讨甲状腺机能亢进 (甲亢 )合并甲状腺微小癌 (thyroidmicrocarcinoma ,TMC)的外科诊断和治疗。方法　分析 1990年 3月～ 2 0 0 3年 8月期间收治的 2 687例甲亢患者中合并甲状腺微小癌的 18例患者的外科诊断和治疗及其预后。结果　本组甲亢与甲状腺微小癌的并存率为 0 .67% ( 18/2 687)。术前确诊 4例 ,术中明确诊断 10例 ,术后病理确诊 4例。其中 2例患者行第二次手术 ,1例补切患侧残余腺体 ,另 1例除补切患侧残余腺体外并加功能性淋巴结清扫。术后随访 10个月～ 14年 ,3例患者再手术后无复发。结论　甲状腺机能亢进合并甲状腺微小癌术前确诊困难 ,术前应详细触诊 ,甲亢患者合并甲状腺结节者应常规作术中快速冰冻切片检查 ,甲状腺叶全切或次全切对治疗甲亢合并甲状腺微小癌具有良好的临床效果     

30例甲状腺微小癌的外科治疗体会

【摘要】 目的 总结甲状腺微小癌的外科治疗经验。方法 回顾性分析2010年5月至2014年5月收治30例甲状腺微小癌患者的临床资料。结果〓30例病例均行手术切除,其中24例(80.00%)术中冰冻切片证实,6例(20.00%)术后病理确诊。24例中,单侧甲状腺腺叶加峡部切除术加中央区颈淋巴结(VI)清扫术14例;双侧甲状腺全切7例;单侧腺叶、峡部切除术加同侧颈淋巴结清扫术3例。术后病理确诊的6例均采用一侧腺体大部切除。全组30例无手术死亡和术后并发症,随访未见肿瘤复发。结论〓单侧甲状腺腺叶及峡部切除是甲状腺微小癌手术治疗较理想的术式;有淋巴结转移者同时行功能性颈部淋巴结清扫术。     

甲状腺微小癌临床诊治：附28例报告

目的:探讨当前甲状腺微小癌(TMC)的诊断及治疗现状,并为进一步规范外科术式的选择提供临床依据。方法:回顾2013年2月—2015年2月间28例手术和病理均证实为TMC患者的临床资料,对其诊断、手术方式及预后等进行分析。结果:28例TMC患者术前彩超检查均发现病灶,15例彩超下细针穿刺确诊者4例(26.7%),术中冷冻切片确诊者27例(96.4%),术后病理确诊者1例(3.6%)。所有患者行手术治疗,包括甲状腺全切除术8例(28.6%)、甲状腺次全切除术7例(25.0%)、甲状腺患侧腺叶+峡部切除术10例(35.7%)、患侧腺叶切除术3例(10.7%)。术后均获随访,无复发、转移或死亡者。结论:TMC的检出率有增高趋势,目前的术前明确诊断仍较为困难,外科手术是主要治疗手段;如何提高术前诊断率与规范化手术治疗已成为当务之急。     

结节性甲状腺肿合并甲状腺微小癌72例临床分析

目的总结结节性甲状腺肿合并甲状腺微小癌的临床特点及其诊断和治疗要点。方法回顾分析1993-01—2010-01手术治疗并病理证实的72例结节性申状腺肿合并甲状腺微小癌患者的临床资料。结果该组72例,占同期手术治疗结节性甲状腺肿患者的6.2%。术前彩超检查可疑恶性者占20.8%。术中快速冰冻检查诊断准确率为98.6%。病理类型以乳头状癌为主(93.1%)。手术方式主要是患侧腺叶+峡部切除+对侧腺叶次全/部分切除。结论结节性甲状腺肿合并甲状腺微小癌以乳头状癌为主,淋巴结转移发生率低。术中快速冰冻检查是诊断结节性甲状腺肿合并甲状腺微小癌的关键。对结节性甲状腺肿合并甲状腺微小癌不做预防性淋巴结清扫是安全的。     

Our experience on surgical treatment of papillary thyroid microcarcinoma

The papillary thyroid microcarcinoma (PTMC) is a subtype of the papillary thyroid carcinoma (PTC) 1 cm or less in diameter, bilateral and multifocal in a percentage of 15-20%. We describe our experience on the surgical treatment of 217 patient treated between 2005 and 2008. Our therapeutic algorithm for PTMC includes always total thyroidectomy with surgical exploration of the median cervical compartment and recurrent laryngeal nerve lymph node dissection, reserving the median lymph node dissection only to the cases with pathological lymph nodes and the lateral compartment lymphectomy to the cases that show suspect nodes with or without positive cytology. We usually perform total thyroidectomy rather than partial one, in relation to the high rate of multifocality of papillary microcarcinoma, to reduce rate of recurrencies and to better utilize I131 with diagnostic and curative aims. Complete central compartment dissection is mandatory when pathological nodes are present at surgical exploration. It prevents nodal recurrencies and decrease number of re-operations, that have a greater number of complications or morbidity, including hypoparathyroidism and inferior laryngeal nerve lesions. The rate of nodal metastases is not affected by the site of primitive tumor, but the tumor size does. The rate of nodal metastases varies from 55.7% for tumors 5 mm or less in diameter, to 73.7% for tumors sized from 5 to 10 mm, and is affected from the capsular infiltration, the presence of multiple foci, and the histological type, i.e. sclerosing type. All patients presenting papillary microcarcinoma with invasion of the capsule and extension to the perithyroid tissues, sclerosing histological type, multifocal and/or metastatic to the regional nodes, were treated with radiometabolic therapy and suppressing l-tiroxin administration, according to the guidelines of the Multidisciplinary Group for the Thyroid Cancer of our Institution.     

分化型甲状腺微小癌的诊断和治疗：附138例报道

目的:探讨分化型甲状腺微小癌(TMC)的临床特征与诊治疗经验。方法:回顾分析2007年1月—2013年12月间经手术及病理证实138例分化型TMC患者的临床资料,并与2012年1月—2013年12月间29例怀疑甲状腺恶性肿瘤而手术的良性甲状腺结节(BTN)患者资料对比分析。结果:138例TMC中,微小乳头状癌131例,微小滤泡状癌5例,微小混合型癌2例;49例合并结节性甲状腺肿,5例与结节性甲状腺肿和桥本甲状腺炎共存,7例合并桥本甲状腺炎,2例合并甲状腺功能亢进。与BTN患者比较,TMC患者中TI-RADS分级恶性诊断率明显升高、砂砾钙化率、超声造影检查中的恶性诊断率均明显升高(均P0.05)。所有TMC患者均行术中快速病理检查,患侧甲状腺全切84例,患侧甲状腺全切+对侧甲状腺部分切除46例,双侧甲状腺全切5例,患侧甲状腺全切+对侧甲状腺近全切除3例;85例患者行患侧中央区气管旁淋巴结清扫,3例患者加行患侧功能性颈部淋巴结清扫术。术后均终生服用甲状腺素片。结论:高分辨率彩超、TI-RADS分级及超声造影联合应用可提高甲状腺TMC诊断率,TMC多为分化好的乳头状癌,高钙化率,患侧腺叶加峡部切除同时行患侧中央区淋巴结清扫是其主要的手术方式。     

甲状腺微小癌（附71例报告）

目的 探讨甲状腺微小癌诊断和外科治疗的经验。方法 总结１９８５年１月至１９９８年８月间经手术和病理证实的甲状腺微小癌７１例,结果 仅有５例术前诊断微小工由病理证实３例出现颈淋巴结转移,１例骨转移,２６例行一侧腺叶全切除加对侧次全切除术,３例加颈淋巴结清扫术,其余行一侧腺叶全切除和一侧或两侧腺叶次全切除,随访病例中,术后复发１例（１．６％）,无一例死亡,结论 甲状腺微小癌发生率较高,提高术术,术中的     

Lateral neck mass as the initial manifestation of thyroid carcinoma

Of 238 thyroid cancer patients, 24 exhibited a lateral neck mass as the initial presentation. Twenty four (77.4%) of 31 metastatic masses were located at the midjugular and lower jugular lymph chains. The average number of histologically proven metastatic nodes was 6.5. Histologically, 22 cases were diagnosed as papillary carcinoma, 1 as follicular carcinoma, and the remaining case as medullary carcinoma. Fifteen thyroid glands were found to have a single primary focus, while 9 others had multiple foci. The mean diameter of the primary foci was 1.2 cm. The rates of detection of primary foci by thyroid scan and ultrasonography were 60% and 37.5%, respectively. Surgical procedures for the thyroid lesions included total or near-total thyroidectomy in 18 cases and lobectomy in 6 cases; for metastatic neck nodes, 13 were treated by modified neck dissection, 5 by standard radical neck dissection, and six by partial neck dissection. All 24 patients were followed for a mean duration of 4.5 years with a range of 2.0 to 7.5 years, and all except 1 are still living. In the presence of a lateral neck mass as the initial manifestation of thyroid carcinoma, no matter what size the primary tumor foci, a total or near-total thyroidectomy appears to be justified in addition to an appropriate neck dissection.     

Thyroid microcarcinoma and multinodular struma. Personal experience and considerations regarding surgical therapy

Thyroid microcarcinoma is a malignant papillary tumour of the thyroid gland measuring < or = 1.0 cm in diameter. Prognosis and treatment are controversial. We report on a personal series of 28 cases of thyroid microcarcinoma observed over the period from 2000 to 2004. From 2000 to 2004, 199 consecutive total thyroidectomies were performed in patients with multinodular struma. The histological diagnosis was made by a pathologist according to the recommendations of the World Health Organization by means of sections of the thyroid gland of no more than 2 mm. At routine histological examination, 28 cases (14.07%) of "incidental" thyroid microcarcinoma were found. The mean tumour size was 4.10 mm (range: 0.12 to 10 mm). The tumours were multifocal in 2 patients, and none presented lymph node metastases. Thyoid microcarcinoma is a malignant tumour associated with a good prognosis. Multifocality should be the main factor considered in selecting the type of thyroid surgery. A total thyroidectomy may be regarded as sufficient treatment.     

Thyroid microcarcinoma: our experience

Differentiated thyroid cancer had an excellent prognosis; the diagnosis of sub-centimetric differentiated cancer (microcarcinoma) is more and more frequently. Clinical evolution of microcarcinoma could be various: microcarcinoma can represent an autoptic finding or can evolve with locoregional lymph node involvement or metastasis. Various clinical and genetic factors have been considered to predict the aggressiveness of this neoplasm. From 2001 to 2004, 74 patients with diagnosis of thyroid microcarcinoma underwent surgical treatment. By a retrospective survey we evaluated risk factors and the choice of surgical treatment. The aggressiveness appear to be related mainly to multifocality and size. Our therapeutic strategy is to perform total thyroidectomy for benign pathologies, total thyroidectomy with lymphadenectomy in cases with preoperative diagnosis of microcarcinoma.     

High Recurrent Rate of Multicentric Papillary Thyroid Carcinoma

Background  Multicentric papillary thyroid carcinoma (PTC) is not unusual in patients with PTC. However, its clinical features concerning cancer recurrence and mortality are not well described. Methods  A total of 1682 PTC patients at a single institution who underwent total thyroidectomy were retrospectively reviewed; the mean follow-up period was 7.7 ± 0.1 years. Postoperative radioactive iodide ablation for thyroid remnant was performed after surgery for most patients. Results  Of all the PTC cases reviewed, 337 cases (20.0%) were categorized as multicentric PTC. Compared with patients with unifocal PTC, multicentric PTC patients demonstrated older age, advanced TNM staging, and higher recurrence. A higher recurrence rate for multicentric PTC (20.2%) was observed compared with that for unifocal PTC; 45.8% of multicentric PTC cases with ≥ 5 foci experienced cancer recurrence. Mean tumor size of the largest nodule in patients with multicentric PTC was significantly smaller than that found in unifocal PTC. Patients with multicentric papillary microcarcinoma (≤1 cm) had higher recurrence rate and cancer mortality than those with unifocal papillary microcarcinoma. Of the recurrent multicentric PTC cases, 52.9% were persistent or diagnosed within the first year of thyroidectomy and had a cancer-related mortality of 27.8%. The 5-, 10-, and 20-year survival rates of multicentric PTC patients were 97.7%, 94.4%, and 84.7%, respectively, which were not statistically different from those of unifocal PTC patients. Conclusions  Multicentric PTC warrant postoperative adjuvant therapy and close surveillance within the first year. Patients with multicentric papillary thyroid microcarcinoma need to be treated as high-risk patients.