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目的分析结节性甲状腺肿合并甲状腺微小癌的临床特征、诊断和行甲状腺全切术+Ⅵ区淋巴结清扫术的必要性。方法回顾性分析23例结节性甲状腺肿合并多灶性甲状腺微小癌病人的诊疗过程和随访结果。结果 23例病人术前均做B超检查,其中诊断为甲状腺微小癌2例(9.1%),可疑为甲状腺微小癌16例(72.7%),上述均为单一病灶;其中可疑癌灶术前行细针穿刺细胞活检8例(36.4%),细胞学检查诊断为甲状腺乳头状癌6例(27.3%);23例病人术中冰冻病理均诊断为甲状腺微小乳头状癌并结节性甲状腺肿,其中仅3例为双侧、多灶性微小癌(13.04%);术后石蜡切片证实23例均为结节性甲状腺肿并多灶性甲状腺微小乳头状癌,多灶性为单侧3例(13.04%)。手术方法均为甲状腺全切术+患侧Ⅵ区淋巴结清扫,合并淋巴结转移15例(65.2%);术后均行促甲状腺激素抑制治疗,其中4例淋巴结转移病人行131I核素治疗。所有病人随访3~64个月,无局部复发或转移。结论术前B超检查、细针穿刺细胞学活检、术中冰冻病理检查有利于提高甲状腺微小癌的诊断率,但这些术前常规诊断方式及术中病理检查会明显低估和漏诊结节性甲状腺肿病人肿多灶性甲状腺微小乳头状癌。多灶性甲状腺微小乳头状癌的诊断有赖于术后石蜡切片病理检查。对合并结节性甲状腺肿的甲状腺微小癌病人应行甲状腺全切术加患侧Ⅵ区淋巴结清扫。
Objective To analyze the clinical characteristics of nodular goiter complicated with thyroid microcarcinoma, and the necessity of diagnosis and total thyroidectomy + Ⅵ lymph node dissection. Methods The clinical course and follow-up results of 23 patients with nodular goiter complicated with multifocal thyroid microcarcinoma were retrospectively analyzed. Results Twenty-three patients underwent preoperative B-ultrasound examination, of which 2 were diagnosed as thyroid microcarcinoma (9.1%), 16 were suspected as thyroid microcarcinoma (72.7%), all of which were single lesions. Fine needle aspiration biopsy in 8 cases (36.4%), cytology diagnosis of papillary thyroid carcinoma in 6 cases (27.3%); 23 cases of intraoperative frozen pathology were diagnosed as small thyroid papillary thyroid carcinoma and nodular goiter, Only 3 cases were bilateral and multifocal small cancers (13.04%). All the 23 cases were nodular goiter with multifocal papillary thyroid carcinoma after operation, and 3 cases were multifocal (13.04%). Surgical methods were total thyroidectomy + ia Ⅵ lymph node dissection, with lymph node metastasis in 15 cases (65.2%); thyroid hormone suppression after treatment were performed, of which 4 cases of lymph node metastasis patients treated with 131I. All patients were followed up for 3 to 64 months without local recurrence or metastasis. Conclusion Preoperative B-ultrasound, fine needle aspiration biopsy and intraoperative frozen pathological examination are helpful to improve the diagnosis rate of thyroid microcarcinoma. However, these preoperative routine diagnostic methods and intraoperative pathological examination will obviously underestimate and missed nodular thyroid Swollen patients with multifocal small thyroid papillary carcinoma. Multifocal thyroid papillary carcinoma depends on the diagnosis of paraffin section pathological examination. Patients with thyroid microcarcinoma with nodular goiter should be treated with total thyroidectomy plus Ⅵ area lymph node dissection.