隐匿性甲状腺癌的诊断及手术治疗(附68例报告)

目的 探讨隐匿性甲状腺癌(occult cancer of the thyroid,OCT)的诊断与治疗.方法 回顾性分析1998年-2008年我院收治并经病理证实的68例OCT患者的临床资料.结果 男性11例,女性57例,年龄15-69岁,中位年龄43.5岁.41例(60.2%)患者因发现甲状腺结节就诊,其中16(39.0%)例临床查体未能发现,后经超声、手术探查发现微小结节;17例(25%)以颈淋巴结肿大为首发症状,经超声检查发现同侧甲状腺中微小结节;68例中66例成功得到随访(随访率97.1%),其中甲状腺腺叶切除术患者44例,改良颈淋巴结清除手术患者22例,其中5例（7.6%)患者死亡,2例患者由于地址更换而失访（失访率2.9%).结论 甲状腺乳头状微小癌起病隐患,术前较难诊断.详细的查体和辅助检查是OCT诊断不可缺少的,手术治疗为甲状腺乳头状微小癌的主要手段.

Diagnosis and surgical treatment of occult cancer of the thyroid: Report of 68 cases

Objective:To investigate the diagnosis and therapy of occult cancer of the thyroid(OCT).Methods: The clinical data of 68 cases with PTMC treated and confirmed by pathology from 1995 to 2000 were retrospectively analyzed.Results: Eleven patients were male and fifty-seven female,with the media age 43.5 years(range from 15 to 69 years).Forty-one(60.2%)cases were first treated for thyroid nodules,of which sixteen patients(39.0%)were found with tiny thyroid nodules by ultrasound and surgical exploration but not physical examination.Seventeen cases(25%)were first treated for deradenoncus.Of the sixty-eight patients sixty-six cases were followed up,of which forty-four patients underwent a lobectomy and twenty-two got modified radical neck dissection,were successfully followed-up,and the follow-up rate was 97.1%;five patients(7.6%) dead,two cases were lost for follow up and the lost rate of follow up was 2.9%.Conclusion: The onset of OCT is latent and is hard to diagnose preoperatively.It is necessary to establish diagnosis by physical examination and accessary examinations.Surgical operative procedure is the major treatment for OCT.