甲状腺微小癌的早期诊断和治疗(附34例临床分析)

目的:探讨B超、FNA、术中冰冻切片在甲状腺微小癌TMC的早期诊断和治疗中的意义.方法:分析1992年～1998年经手术和病理证实的甲状腺微小癌34例的临床资料.结果:术前拟诊32例,B超诊断阳性率94.4%(32/34),FNA诊断阳性率81.1%,冰冻切片诊断阳性率90%,术后病理检查确诊微小癌34例,其中术中冰冻切片未发现3例,4例作患侧甲状腺叶加对侧甲状腺次全切除和双侧甲状腺次全切除术,28例行患侧甲状腺叶切除术:2例患侧甲状腺叶切除加改良性颈淋巴结清扫术,随访率88%(30/34),随访时间5～10年;1例对侧复发,无一例死亡.结论:B超结合FNA、术中冰冻检查能提高甲状腺微小癌的临床诊断率,有临床价值.甲状腺叶或次全切除治疗微小癌具有较好的疗效.

Thyroid Microcarcinoma: the Early-stage Diagnosis and Treatment

Objective: To evaluate ultrasonography?FNA and intraoperative freezing section as the early-stage diagnostic and treatment means of thyroid microcarcinoma (TMC). Methods: Clinical diagnosis and therapeutic data for 34 cases of postoperated patients with TMC confirmed by pathology in rhe period from 1992 to 1998 were analyzed. Results: Diagnostic positive rates by ultrasonography, FNA and freezing section were 94.4%(32/34), 81.1% and 90%, respectively in 32 cases diagnosed preoperatively. Through postoperative pathologic exam, 34 cases were confirmed as TMC that was not discovered in 3 cases by intraoperative freezing section. Near total thyroidectomy was performed in 4 cases, lobectomy of one lobe in 28 cases, combined with cervical lymph node dissection were adopted in 2 cases. Follow-up rate was 88%(30/34) with time ranging from 5 years to 11 years. One case recurred on opposite side and without mortality. Conclusion:Ultrasonography in combination with FNA before operation and intraoperative freezing section will help to increase the diagnostic rate, so it has the value of clinical use. Total or near-total lobectomy fulfils the eradication of TMC.