分化型甲状腺微小癌的诊断和治疗：附138例报道

目的:探讨分化型甲状腺微小癌(TMC)的临床特征与诊治疗经验。方法:回顾分析2007年1月—2013年12月间经手术及病理证实138例分化型TMC患者的临床资料,并与2012年1月—2013年12月间29例怀疑甲状腺恶性肿瘤而手术的良性甲状腺结节(BTN)患者资料对比分析。结果:138例TMC中,微小乳头状癌131例,微小滤泡状癌5例,微小混合型癌2例;49例合并结节性甲状腺肿,5例与结节性甲状腺肿和桥本甲状腺炎共存,7例合并桥本甲状腺炎,2例合并甲状腺功能亢进。与BTN患者比较,TMC患者中TI-RADS分级恶性诊断率明显升高、砂砾钙化率、超声造影检查中的恶性诊断率均明显升高(均P0.05)。所有TMC患者均行术中快速病理检查,患侧甲状腺全切84例,患侧甲状腺全切+对侧甲状腺部分切除46例,双侧甲状腺全切5例,患侧甲状腺全切+对侧甲状腺近全切除3例;85例患者行患侧中央区气管旁淋巴结清扫,3例患者加行患侧功能性颈部淋巴结清扫术。术后均终生服用甲状腺素片。结论:高分辨率彩超、TI-RADS分级及超声造影联合应用可提高甲状腺TMC诊断率,TMC多为分化好的乳头状癌,高钙化率,患侧腺叶加峡部切除同时行患侧中央区淋巴结清扫是其主要的手术方式。

Diagnosis and treatment of differentiated thyroid microcarcinoma: a report of 138 cases

Objective: To investigate the clinical features as well as diagnosis and treatment strategies of differentiated thyroid microcarcinoma (TMC). Methods: The clinical data of 138 patients with differentiated TMC confirmed by surgical and pathological findings from January 2007 to December 2013 were reviewed, and were comparatively analyzed with the data of 29 patients with benign thyroid nodules who during the same period of time underwent surgery with the suspicion of thyroid cancer. Results: Of the 138 TMC patients, 131 cases were papillary TMC, 5 cases were follicular TMC, and 2 cases were mixed TMC; 49 cases were complicated with nodular goiter, 5 cases with nodular goiter and Hashimoto’s thyroiditis, 7 cases with Hashimoto’s thyroiditis, and 2 cases with hyperthyroidism. In TMC patients, the malignancy diagnostic rate by TI-RADS classification, and the incidence of gravel-like calcification and malignancy diagnostic rate by contrast-enhanced ultrasound were all significantly higher than those that in BTN patients (all P<0.05). All the TMC patients underwent intraoperative rapid pathological assessment, 84 cases underwent ipsilateral thyroidectomy, 46 cases underwent ipsilateral thyroidectomy plus contralateral partial thyroidectomy, 5 cases underwent bilateral total thyroidectomy, and 3 cases underwent ipsilateral thyroidectomy plus contralateral subtotal thyroidectomy; 85 cases received central lymph node dissection and 3 cases had additional ipsilateral functional neck dissection. All the TMC patients were prescribed lifelong thyroxine therapy after surgery. Conclusion: High-resolution ultrasound combined with TI-RADS or contrast-enhanced ultrasound can improve the detection rate of TMC. Well-differentiated papillary thyroid cancer and high calcification rate is frequently seen in TMC, and ipsilateral thyroidectomy plus isthmectomy with simultaneous central cervical lymph node dissection is the major surgical procedure for TMC.