双侧甲状腺乳头状癌的临床诊治分析

目的探讨双侧甲状腺乳头状癌（PTC）的临床诊断及手术治疗的有关问题。方法回顾分析2005年1月至2010年6月收治的19例PTC患者的临床资料，总结其术前诊断、术中病理及手术治疗的特点。结果167例甲状腺癌患者中共发现PTC19例（11．4％）；术前通过超声造影和CT检查拟诊为双侧甲状腺癌仅1例（5．3％）；术中冰冻切片检查确诊为双侧乳头状癌17例（89．5％）。其中行双侧甲状腺切除术11例，行一侧腺叶切除加峡部及对侧甲状腺次全或部分切除7例，双侧甲状腺近全切除1例。同时行双侧中央区淋巴结清扫术5例，一侧中央区淋巴结清扫术7例，一侧功能性颈淋巴结清扫术1例。术后病理证实为中央区淋巴结转移共7例（36．8％）。结论双侧甲状腺乳头状癌的术前诊断较为困难，术前超声造影结合CT检查可提高甲状腺癌的诊断符合率。PTC手术时应以全甲状腺切除为主，并行双侧中央区淋巴结清扫。对明确有中央区淋巴结转移者，可同时行一侧功能性颈淋巴结清扫术。

Clinical diagnosis and treatment of bilateral papillary thyroid carcinoma

Objective To analyze the diagnosis and treatment of bilateral papillary thyroid carci- noma（ BPTC ）. Methods The clinical data of 19 patients who were treated in our hospital from January 2005 to June 2010 were retrospectively analyzed. Preoperative diagnosis, intraoperative pathologic diagnosis and the surgical procedures were summarized. Results There were 19（ 11. 4% ）patients with BPTC in all 167 PTC patients. Only 1 patient was diagnosed as having BPTC before operation. Seventeen（ 89.5% ）pa- tients with BPTC were confirmed with intraoperative frozen section examination. All of the 19 BPTC patients received surgery, including total thyroidectomy （ n = 11,57.9% ）, bilateral subtotal thyroidectomy （ n = 1 ）, unilateral thyroid and isthmic portion and/or bilateral thyroid partial thyroidectomy （ n = 7 ）. Among them ,5 patients received bilateral central zone lymph node dissection ,7 patients received unilateral central zone lymph node dissection, and 1 patient received functional cervical lymph node dissection. A total of 7 patients（ 36.8% ）were pathologically confirmed having lymph node metastasis in central zone after opera- tion. Conclusion Due to the lack of specific diagnostic methods,it＇s difficult to confirm BFYC before op- eration. Contrast enhanced uhrasonography combined with CT examination can improve the preoperative diagnosis of BPTC. Total thyroidectomy and bilateral central zone lymph node dissection are the first choice for BPTC patients. Functional cervical lymph node dissection is necessary for patients with central lymph nodes metastases.