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目的探讨甲状腺良性病变合并甲状腺微小癌(TMC)的诊断和治疗。方法分析1994年1月~2004年12月收治的经外科手术和病理证实为甲状腺良性病变合并甲状腺微小癌28例临床资料。结果术前确诊2例,仅占7.1%,28例均送术中冰冻切片检查发现阳性16例,诊断阳性率57.4%,17例术前、术中确诊者行患侧腺叶并峡部切除,颈VI区淋巴结清除术,平均随访4~6年无复发。术后病理确诊者3例见手术标本周围组织癌细胞浸润,包膜受侵犯,再次手术后无复发。结论甲状腺微小癌漏诊率高,术前术中要高度重视质实可凝小结节,提高术中冰冻切片阳性率是关键。对于甲状腺良性肿瘤应常规行腺叶切除,可避免二次手术。术前术中确诊者应行患侧腺叶+峡部切除,颈VI区淋巴结清扫术。术后确诊者应检查TMC周围组织有无癌细胞浸润,包膜有无侵犯,如证实TMC已完整切除,则不必再行手术,如发现包膜受侵犯或切缘有癌细胞浸润,应补行二次手术。
Objective To investigate the diagnosis and treatment of thyroid benign disease complicated with thyroid microcarcinoma (TMC). Methods From January 1994 to December 2004, the clinical data of 28 cases with thyroid benign lesions complicated with thyroid microcarcinoma proved surgically and pathologically were analyzed. Results Preoperative diagnosis of 2 cases, only 7.1%, 28 cases were sent intraoperative frozen section examination found positive in 16 cases, the diagnostic positive rate was 57.4%, 17 cases of preoperative and intraoperative confirmed patients with ipsilateral lobectomy and isthmus resection, Cervical VI lymph node dissection, the average follow-up of 4 to 6 years without recurrence. Postoperative pathological diagnosis of 3 cases, see the surgical specimens around the cancer cell infiltration, capsule invasion, no recurrence after surgery. Conclusions The rate of misdiagnosis of thyroid microcarcinoma is high. It is necessary to attach great importance to the quality of coagulation nodules before surgery. It is the key to improve the positive rate of intraoperative frozen section. For benign thyroid tumors should be routine gland lobectomy, to avoid the second surgery. Preoperative diagnosis should be performed in patients with ipsilateral ipsilateral lobectomy, cervical lymph node dissection. Postoperative diagnosis of TMC should check the surrounding tissue with or without cell infiltration, whether the invasion of the capsule, such as TMC confirmed complete resection, you do not have to re-surgery, such as found in the envelope invasion or marginal cancer cell infiltration, should make up Second surgery.