65例甲状腺微小癌的诊治分析

目的探讨甲状腺微小癌的诊治经验。方法回顾分析2002年1月-2008年12月深圳大学第一附属医院手术病理证实的65例甲状腺微小癌的临床资料。结果术中冰冻切片确诊55例（84．6％），10例术后石蜡切片确诊。10例术后确诊患者未行二次手术，随访3个月～7年，与其余55例患者比较复发率差异无统计学意义。结论术前触诊、B超检查、术中探查及冰冻组织切片对提高甲状腺微小癌的诊断率非常重要。术中明确诊断的微小癌手术应以患侧腺叶加峡部全切，对侧次全切为宜。术后确诊的微小癌如果已行患侧腺叶次全切或全切，可暂不行二次手术，但应密切观察。有颈淋巴结转移者行功能性颈淋巴结清扫术，对于术前彩超未发现及术中未触及淋巴结肿大的患者，不宜做预防性颈清扫。

Diagnosis and Treatment of Thyroid Micro-carcinoma:a Report of 65 Cases

Objective To discuss the diagnosis and treatment of thyroid micro-carcinoma. Methods The clinical data of 65 cases with thyroid micro-carcinoma confirmed pathologically in our hospital from 2002 to 2008 were analyzed Retrospective. Resuits There were 55 cases were confirmed by frozen biopsy, accounting for 8g. 6% , and another 10 cases were confirmed by paraffin-embedded biopsy after operations. These 10 patients did not undergo remedial surgery. The follow-up of 3 months to 7 years showed that the difference has no statistical significance as compare to other 55 cases. Conclusion It is meaningful for confirming micro carcinoma by preoperative palpation, color Doppler ultrasound, and frozen biopsy. The clear diagnosed micro-cancers are appropriate to accept leaf gland isthmus total resection and contra lateral sub-total resection. Cancer diagnosed after small side trip if you have glandular leaf subtotal or total resection cut may not line remedial surgery, but should be closely observed. The functional cervical lymph node dissection is necessary for the patients who have confirmed cervical lymph node metastasis, but no for cases without touching enlargement of lymph nodes.