甲状腺微小癌临床诊治：附28例报告

目的:探讨当前甲状腺微小癌(TMC)的诊断及治疗现状,并为进一步规范外科术式的选择提供临床依据。方法:回顾2013年2月—2015年2月间28例手术和病理均证实为TMC患者的临床资料,对其诊断、手术方式及预后等进行分析。结果:28例TMC患者术前彩超检查均发现病灶,15例彩超下细针穿刺确诊者4例(26.7%),术中冷冻切片确诊者27例(96.4%),术后病理确诊者1例(3.6%)。所有患者行手术治疗,包括甲状腺全切除术8例(28.6%)、甲状腺次全切除术7例(25.0%)、甲状腺患侧腺叶+峡部切除术10例(35.7%)、患侧腺叶切除术3例(10.7%)。术后均获随访,无复发、转移或死亡者。结论:TMC的检出率有增高趋势,目前的术前明确诊断仍较为困难,外科手术是主要治疗手段;如何提高术前诊断率与规范化手术治疗已成为当务之急。

Clinical diagnosis and treatment of thyroid microcarcinoma: a report of 28 cases

Objective: To investigate the present status of diagnosis and treatment for thyroid microcarcinoma (TMC), and provide clinical basis for standardization of surgical procedure selection. Methods: The clinical data of 28 TMC patients confirmed by surgical and pathological findings from February 2013 to February 2015 were reviewed, and the diagnosis, surgical method and prognosis of the patients were analyzed. Results: Of the 28 TMC patients, all cases were detected with lesions by preoperative color Doppler ultrasound evaluation, 15 cases underwent ultrasound-guided fine-needle aspiration biopsy and diagnosis was made in 4 cases (26.7%), 27 cases (96.4%) were diagnosed by intraoperative frozen section, and one case (3.6%) was confirmed by postoperative pathology. All patients received surgical treatment that included total thyroidectomy in 8 cases (28.6%), subtotal thyroidectomy in 7 cases (25.0%), ipsilateral thyroidectomy plus isthmectomy in 10 cases (35.7%), and thyroid lobectomy in 3 cases (10.7%). All patients were followed up, and no recurrence, metastasis or death occurred. Conclusion: The detection rate of TMC shows an increasing trend, and currently, preoperative definite diagnosis is still difficult and surgery is the main treatment method. How to improve the preoperative detection rate and standardized surgical treatment is imperative.