家族性甲状腺乳头状微小癌8例分析

目的总结家族性甲状腺乳头状微小癌（PTMC）的临床特征和诊治方法。方法分析经手术和病理学检查证实的8例家族性甲状腺乳头状微小癌临床资料。结果8例患者随访时间9～13个月,平均10．8个月。无复发及死亡,未发现远处转移。因甲状腺良性病变手术而发现微小癌2例,另6例术前怀疑为甲状腺癌,经病理证实为微小癌。颈部淋巴结转移2例均发生于颈深上组淋巴结。腺叶多发结节2例均发生颈部淋巴结转移,单发结节6例未发生颈部淋巴结转移。2例先期手术后,亲属中11人行常规甲状腺彩色超声检查,6例发现甲状腺结节,经手术和病理证实均为甲状腺乳头状微小癌。结论PTMC多数在良性结节术中或术后病理检查发现,家族性发病罕见。术前触诊、彩色超声检查、术中探查及冰冻组织切片对提高甲状腺乳头状微小癌的诊断非常重要。对甲状腺肿瘤高发区患者亲属进行筛查有助于早期发现肿瘤。患侧腺叶切除术作为常规术式可以避免二次手术。

Diagnosis and treatment of 8 cases of familial papillary microcarcinoma of the thyroid

Objective To summarize the clinical characteristics,diagnosis and therapy of familial papillary thyroid microcarcinoma(PTMC).Method The clinical datas of 8 cases of familial papillary thyroid microcarcinoma admitted were analyzed.Results All patients were followed-up for 9 to 13(mean 10.8)months.No one suffered re- currence and death.PTMC was found in 2 cases incidentally from thyroid specimens removed for supposed benign disease,another 6 cases were doubtful of cancer before operation and were identified by frozen section.Upper deep cervical lymph nodes were involved in 2 cases with lymph node metastasis.Lymph node metastasis in cases of multi- focal cancer in the affected lobe or of both lobe was significantly higher than in monofoccal cancer in uni-lobe.Con- clusion Most of the PTMC are found among the benign nodules during operation or within the pathological speci- mens,and familial papillary thyroid microcarcinomas are very rare.Careful palpation,color Doppler ultrasonography, exploratory operation and frozen section are very important factors to heighten diagnosis of PTMC.Lobectomy is the routine radical operation.