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目的探讨双侧甲状腺微小乳头状癌的预测因素及其手术治疗策略。方法分析了浙江大学医学院附属第一医院甲状腺乳腺外科2011年1月至2012年6月收治269例甲状腺全切或近全切除的微小乳头状癌(PTMC)临床病理学资料,寻找双侧癌的独立预测因素,并探讨其手术治疗策略。结果肿瘤直径≥5 mm及肿瘤多发病灶和双侧癌显著相关(P<0.05),而肿瘤多发病灶是双侧癌的独立预测因素(OR=2.251)。双侧癌中中央区淋巴结转移为49.1%,行甲状腺全切或近全切除加中央区淋巴结清扫不增加术后并发症的发生风险。结论肿瘤多发病灶是预测双侧微小癌的独立预测因素,双侧微小癌有较高的中央区淋巴结转移率,有经验的甲状腺外科医师在甲状腺全切或近全切除后加做中央区淋巴结清扫是安全必要的。
Objective To investigate the prognostic factors of bilateral thyroid papillary carcinoma and its surgical treatment strategies. Methods The clinicopathological data of 269 cases of thyroidectomized papillary carcinoma (PTMC) resected from January 2011 to June 2012 in the First Affiliated Hospital of Medical College of Zhejiang University from January 2011 to June 2012 were analyzed. Independent predictors, and explore the surgical treatment strategy. Results Tumor diameter ≥5 mm and multiple tumor lesions were significantly correlated with bilateral cancer (P <0.05). Multiple tumor lesions were the independent predictors of bilateral cancer (OR = 2.251). Bilateral cancer in the central lymph node metastasis was 49.1%, total thyroidectomy or near total resection plus central lymph node dissection does not increase the risk of postoperative complications. Conclusion Multiple tumor lesions are independent predictors of bilateral micro-cancer. Bilateral micro-cancer has a high rate of central lymph node metastasis. Experienced thyroid surgeons add central lymph node dissection after total or near total thyroidectomy It is safety necessary.