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。

Clinical analysis of 72 cases of nodular goiter thyroid microcarcinoma

Objective To summarize the clinical characteristics and the highlight of diagnosis and treatment of nodular goiter in patients with coexistent thyroid microcarcinoma. Methods A total of 72 nodular goiter coexisting with thyroid microcarcinoma patients underwent operations from January 1993 to January 2010 at my Hospital were retrospectively reviewed. Results Seventy two patients accounted for 6.2% in nodular goiter patients at the same time. 20.8% of tumors were suspected as malignant lesions by preoperative ultrasound exanunation. The accuracy rate of intra - operative fast frozen section pathological examination was 98.6%. The main pathological type was papillary carcinoma （93.1% ）. The main styles of thyroidectomy were performed with ipsilateral total lobectomy ＋ isthmusectomy ＋ contralateral subtotal lobectomy. Conclusion The nodular goiter coexisting with thyroid microcarcmoma patients were often well differentiated papillary cancer and have lower incidence of lymth node metastasis. The intra - operative fast frozen section examination is helpful for the diagnosis of thyroid microcarcinoma in nodular goiter. Lymphadenectomy is unnecessary for patients without lymph node metastasis.