甲状腺微小癌的临床特征及早期诊断

目的探讨甲状腺微小癌（thyroid microcaminoma，TMC）的临床特点及早期诊断。方法回顾性分析76例TMC的临床及影像学特征。结果76例TMC中，术前甲状腺物理检查触及肿块或结节19例（25％）；常规健康查体中经B超检查发现肿物或结节68例（89．47％）；在甲状腺良性疾病手术中发现8例（10．53％）。所有病例术前经颈部B超检查，均证实为甲状腺实性占位或结节，其中双侧10例，单侧66例；低回声无包膜型63例（82．89％），有包膜型13例（17．11％）；结节伴钙化51例（67．10％）。CT或MRI扫描检查发现肿物64例（84．21％），其中肿物边界不清的56例（87．5％）；结节伴钙化42例（65．63％）。行甲状腺核素扫描55例，其中报告为“温结节”10例（18．18％）；呈现为“凉结节”或“冷结节”28例（50．90％）；未显示17例（30．91％）。结论TMC虽术前诊断困难，但通过定期综合查体，结合B超、CT／MRI、ECT等影像学检查，进行综合分析，大部分病例可以得到早期诊断。

Clinical features and early diagnosis of thyroid micro-carcinoma

To investigate the clinical features and management of thyroid features and imaging characteristics of 76 patients were retrospectively analyzed. Results Of 76 cases, tumors in 19 cases （25%） could be touched by thyroid physical examination before the operations, in 68 cases（89.47% ） were determined by B ultrasonograpby in regular physical checkups, and in 8 cases（10.53% ） were found by chance during benign thyrode tumor operations. All were confirmed by neck B uhrasonography before the operations, of them 10 were double thyroid tumors, 66 were unilateral, and 63 （82.89%） were hypoechoic and had no capsule. 51（67.10%） were calcific tuber. 64 （84.21%） cases were found by CT/MRI scanning before the operations, d them 56（87.5% ） had no capsule, and 42 （65.63%） were calcific tuber. 55 cases were detected by nuclein scanning, of them 10（18.18%） were warm tuber, 18 （50.90%） were cold tuber, and 17 （30.91%） were not shown. Conclusion TMC is difficult to diagnose before the operations, but by regular physical checkups, B ultrasonography, CT/MPd, ECT scan and other imagining examinations, most of them could be diagnosed.