甲状腺全切除术治疗甲状腺微小癌128例临床分析

目的：分析甲状腺微小癌的临床、病理特点，探讨甲状腺全切除术在治疗甲状腺微小癌中的意义。 方法：回顾性分析2009年10月—2012年12月经手术和病理证实的128例甲状腺微小癌患者的临床资料。患者均行甲状腺全切除术，部分行辅助131I治疗。 结果：128例患者中，单发微小癌87例（67.97%），多发微小癌41例（32.03%）；单发微小癌肿瘤直径均在0.3 cm以上，术前经超声检查可发现病灶；多发微小癌术前超声可明确所有病灶者25例（60.98%），另16例（39.02%）多发微小癌中除较大的病灶（>0.3 cm）在术前超声检查中明确外，其余病灶均是在术中冷冻切片中发现或术后石蜡切片中发现；多发病灶局限于单侧甲状腺腺体者 22例（53.66%），分散于双侧腺体者19例（43.34%）。术后随访率100%，1例出现颈部淋巴结转移。 结论：掌握甲状腺微小癌的临床、病理特点，仔细检查，可避免漏诊；甲状腺全切除术对治疗甲状腺微小癌有重要意义。

Total thyroidectomy for thyroid microcarcinoma: a clinical analysis of 128 cases

Objective: To analyze the clinical and pathological features of thyroid microcarcinoma and assess the value of total thyroidectomy in the treatment of this condition. Methods: The medical records of 128 patients with thyroid microcarcinoma confirmed by surgical and pathological findings from October 2009 to December 2012 were retrospectively analyzed. All patients underwent total thyroidectomy and some of them also received adjuvant 131I therapy. Results: Of the 128 patients, single focus of microcarcinoma was found in 87 cases (67.97%), and multiple foci of microcarcinoma were found in 41 cases of (32.03%). The diameters of lesions in patients with single focus of microcarcinoma were all larger than 0.3 cm and were able to be detected by preoperative ultrasound; among patients with multiple foci of microcarcinoma, all of the lesions in 25 cases (60.98%) were clearly identified by preoperative ultrasound, while in the other 16 cases (39.03%), preoperative ultrasound could detect those lesions that were larger than 0.3 cm and the other lesions were found by intraoperative frozen section or postoperative paraffin sections. The multiple lesions in 22 patients (53.66%) were confined to only one side of the thyroid gland and 19 cases (43.34%) involved both sides. Postoperative follow-up rate was 100%, and one patient developed cervical lymph node metastases. Conclusion: Better understanding of the clinical and pathological characteristics of thyroid microcarcinoma, along with extensive examination may avoid missed diagnosis; total thyroidectomy is of proven value in treatment of thyroid microcarcinoma.