甲状腺微小癌63例临床诊疗分析

目的 探讨甲状腺微小癌的临床特征、诊断和外科治疗方式。方法 回顾性分析2005年1月至2014年8月63例甲状腺微小癌患者的临床资料，对诊断情况、手术方式、临床病理特征及随访结果进行分析。结果 术前彩超怀疑甲状腺微小癌32例（50.8％）；术前彩超引导下细针穿刺活检4例（6.4％），确诊3例（4.8％）；术中冰冻切片病理确诊41例（74.6％），63例均经术后病理组织学证实为乳头状癌。63例中行甲状腺全切除12例，双侧次全切除17例，患侧及峡部全切除+对侧次全切除20例，患侧次全切除+对侧及峡部全切除8例，患侧及峡部全切除4例，患侧及峡部全切除+对侧部分切除2例；2例行功能性淋巴结清扫，4例行中央区淋巴结清扫。术后随访1年3个月至10年11个月，失访1例；62例患者均存活，其中1例复发，行残余甲状腺全切除术。结论 甲状腺微小癌手术治疗总体预后相对较好，但个别病例有较强的侵袭性，应强调治疗方案个体化。

Clinical diagnosis and treatment of 63 cases of thyroid microcarcinoma

Objective To investigate clinical characteristics, diagnosis and surgical treatment for thyroid microcarcinoma. Methods Sixty-three patients with thyroid microcarcinoma from January 2005 to August 2014 were enrolled. The clinical data inclu-ding diagnosis, surgical treatment, clinicopathological characteristics and follow-up results were reviewed. Results There were 32 ca-ses ( 50. 8%) suspected of micocarcinoma by color Doppler ultrasound before operation. Biopsy by fine-needle aspiration guided by col-or Doppler ultrasound were performed in 4 cases ( 6. 4%) before operation, and 3 ( 4. 8%) of them were confirmed. There were 41 ca-ses (74. 6%) confirmed by frozen section pathological diagnosis during operation. Postoperative pathologic diagnosis of 63 cases was papillary carcinoma. Total thyroidectomy was performed in 12 cases. Subtotal thyroidectomy was performed in 17 cases. Lobectomy and isthmectomy for tumor side and subtotal lobectomy for another side were performed in 20 cases. Subtotal lobectomy for tumor side and lobectomy for another side and isthmectomy were performed in 8 cases. Lobectomy and isthmectomy were performed in 4 cases. Lobecto-my and isthmectomy for tumor side and partial lobectomy for another side were performed in 2 cases. Functional neck dissection was performed in 2 cases. Central district dissection was performed in 4 cases. Follow-up was ranged from 1 year and 3 months to 10 years and 11 months, and 1 case lost contact in our survey;62 patients were alive, among them 1 case was found recurred after surgery and total thyroidectomy was performed then. Conclusion The prognosis of most of thyroid microcarcinoma is satisfied by surgical treat-ment, but partially is aggressive. Individualized treatment should be emphasized.