甲状腺乳头状微小癌42例临床分析

目的 总结甲状腺乳头状微小癌(PTMC)的诊治经验.方法 对42例PTMC的临床资料进行回顾性分析.结果 有25例临床查体未触及的PTMC经高分辨率甲状腺超声发现.19例行冰冻病理检查，其中14例经术中冰冻切片检查确诊；30例接受腺叶切除术，其中11例补充Ⅵ区淋巴结清扫，随访期间无复发.3例行甲状腺大部切除的多发病灶患者随访期间复发.对术后复发有统计学意义的影响因素为PTMC多灶性(P＜0.05)和患侧甲状腺余留量(P＜0.01).结论甲状腺乳头状微小癌起病隐匿，术前较难诊断.大多数临床未能触及的PTMC可经高分辨率超声检出并经术中冰冻切片确诊.手术为PTMC的主要治疗手段，对于颈侧区临床淋巴结阴性的PTMC患者施行腺叶切除加Ⅵ区淋巴结清扫是可行的.

A clinical study on papillary thyroid microcarcinom,report of 42 cases

Objective To evaluate our experience in the diagnosis and surgical management of papillary thyroid microcarcinoma(PTMC). Methods Clinical data of 42 PTMC cases were retrospectively analyzed. Results Twenty-five clinically nonpalpable PTMC were detected by high resohition thyroid uhrasonography preoperatively.The diagnosis of PTMC was established intraoperatively by frozen biopsy in 14 out of 19 cases undergoing this procedure.Of the 42 patients,30 underwent a lobectomy,and in 11 out of 30 patients supplemented level Ⅵ lymph node dissection was performed.None of these patients had recurrence during follow-up.The recurrence in three patients with multffocal lesions and undergoing incomplete resection were observed at follow.up.The mulifocality of PTMC and ipsilateral residual volume of the thyroid were two predicting factors that significantly influence the postoperative recurrence(P＜0.05,P＜0.01 respectively)in patients with PTMC. Candus-ions PTMC is usually occult and eludes correct preoperative diagnosis.Most PTMC are clinically nonpalpable and may be detected by hish resolution thyroid ultrasonography and diagnosed by frozen section during the operation.Surgery is the most important treatment of PTMC.Lobectomy plus level Ⅵ lymph node dissection is the therapy of choice for PTMC patients at the stage of cN0.