61例甲状腺微小乳头状癌临床诊治分析

背景与目的：近年来，甲状腺微小乳头状癌的发病率逐年增高。在诊断、治疗方面业界存在诸多分歧。该研究通过分析患者资料，总结并探讨甲状腺微小乳头状癌的临床诊治特点。方法：回顾性分析2012年2月-2015年1月于山西大医院耳鼻咽喉头颈外科收治的61例经病理证实的甲状腺微小乳头状癌患者资料。结果：61例患者术前均行颈部高分辨率超声检查，准确率为86.89%。所有患者均接受手术治疗，接受患侧叶及峡部切除+同侧中央区淋巴结清扫术者共39例，其中11例同期行对侧叶部分切除术；接受甲状腺全切+双侧中央区淋巴结清扫术者共22例。5例同期行颈侧淋巴结清扫术。27例发生中央淋巴结转移(44.3%)，5例发生颈侧区淋巴结转移(8.2%)。年龄<45岁、多灶性病变、肿瘤位置跨越或接近中线、肿瘤最大径大于等于5 mm者更易发生颈部淋巴结转移(P<0.05)，中央区淋巴结转移率分别为66.7%、60.7%、66.7%和53.8%。结论：高分辨率超声检查对甲状腺微小乳头状癌诊断灵敏度较高，规范化及个体化的手术方式对甲状腺微小乳头状癌患者具有重要意义。

Diagnosis and treatment of papillary thyroid micro-carcinoma: An analysis of 61 cases

Background and purpose:During recent years, the incidence of papillary thyroid micro-carcinoma (PTMC) has increased year by year. There are many differences in its diagnosis and treatment. This research investigated and summarized the clinical diagnosis and treatment of thyroid papillary carcinoma by means of analyzing the patients’ data.Methods:Sixty-one cases underwent high resolution ultrasound examination before operation, and the accuracy rate was 86.9%. All patients underwent surgical treatment. Thirty-nine patients had thyroid lobectomy and ipsilateral central lymph node dissection (CLND), 11 underwent concurrent partial thyroidectomy, 22 had total thyroidectomy and bilateral central lymph node dissection and 5 underwent concurrent cervical lymph node dissection. The incidences of central and cervical lymph node metastasis were 44.3% and 8.2%, respectively. Univariate analysis showed that the risk factors for central lymph node metastasis were age <45 years, multifocality, tumor location near or across the midline, tumor diameter≥5 mm. The rates of central lymph node metastasis were 66.7%, 60.7%, 66.7% and 53.8, respectively.Conclusion:High resolution ultrasound examination has a high sensitivity for the detection of PTMC. It is important to implement standardized and individualized treatment plan to the patients with PTMC.