隐匿性甲状腺癌34例分析

目的 探讨隐匿性甲状腺癌的诊断与治疗。方法 对34例隐匿性甲状腺癌的临床资料进行回顾性分析。结果 6例术前获得诊断；16例行患侧腺叶及峡部切除术，其中14例加颈淋巴结清扫术，18例行双侧腺叶次全切除术；病理见34例癌灶均位于单侧腺叶，有颈淋巴结转移者4例。15例在癌灶内及其周围甲状腺组织内查见砂粒体；随访31例，平均随访时间为9年，1例死于肺转移，2例死于其他疾病，结论 （1）甲状腺组织内查到砂粒体，应警惕存在癌的可能性；（2）治疗应选择一侧腺叶全切或次全切除术，癌已穿透甲状腺被膜者应行颈淋巴结清扫术。

Occult thyroid carcinoma:report of 34 cases

ObjectiveTo investigate the diagnosis and treatment of occult thyroid carcinoma(OCT).MethodsRetrospective analysis on the clinical data of 34 cases of OCT was made. ResultsOnly 6 cases were preoperatively diagnosed as OCT. Total resection of the affected lobe and isthmus was performed on 16 cases with neck dissection in 14 cases. Subtotal thyroidectomy was performed on 18 cases. The occult cancer lesion was pathologically confirmed within ipsolateral lobe in all the 34 cases. Neck lymph node metastasis was found in 4 cases and local infiltration in 3 cases. The psammoma bodies in cancer lesion and adjacent normal gland were found in 15 cases. Thirty-one cases were followed up for an average of 9 years. One died of lung metastasis and two more of other unrelated diseases. Conclusion(1) The psammoma bodies in normal thyroid gland usually imply the existence of cancer. (2) Total thyroidectomy of a lobe or subtotal thyroidectomy was the therapy of choice. Local infiltration or neck lymph node metastasis necessitates additional neck dissection.