合并转移的甲状腺微小癌诊治(附16例分析)

目的：探讨合并转移的甲状腺微小癌的危害性及其诊断和治疗。方法：总结我科１９７８～２０００年收治的合并转移的甲状腺微小癌１６例，结合文献进行临床分析。结果：术中及住院期间无一死亡。５例发生术后转移（３１.２５％），远处转移为主，与同期无转移的甲状腺微小癌９２例相比（仅２例复发），具有明显统计学意义上的差别（Ｐ＜０．００１）。病理切片结果提示本组资料的癌灶均已穿透包膜，存在包膜外血管浸润。其中７例因远处转移于术后５年内死亡。结论：应高度重视本病的危害性。掌握本病的临床特点，甲状腺Ｂ超检查结合转移灶穿刺活检可提高其诊断率。手术为首选治疗方法。术后可辅以甲状腺素Ｉ同位素或化疗等治疗。

Occult Thyroid Cancer with Metastases(Report of 16 Cases)

To study the impact of metastases on the prognosis of occultthyroid cancer,and its pertinent diagnostic and therapeutic features. Methods: Sixteen cases of occult thyroid cancer were admitted from 1978 to 2000; analysis of the cases was made and related literatures were reviewed. Results: No death occurred during hospitalization. Postoperative recurrence manifesting as distant metastases occurred in 5 cases(31.25%), while recurrence occurred in only 2 out of 92 cases of occult thyroid cancer without metastases during the same period(P＜0.001). Pathologic examination showed in all the 16 cases that the tumor had penetrated through the capsule and invaded the extracapsular blood vessels. Seven cases died of systemic metastases during the five years following operation. Conclusions: Greater attention should be paid to occult thyroid cancer with metastases. Mastering the clinical features and performing needle biopsies under the guidance of ultrasonography on the primary tumor and the metastatic focus were the key points for diagnosis. Adequate postoperative administration of radio-isotope 131I is still the treatment of choice.