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目的:探讨甲状腺微小乳头状癌(PTMC)的临床病理特征及诊治策略。方法:回顾性分析2011年6月—2016年5月经手术与病理证实的47例PTMC患者临床资料。结果:47例患者中,男9例,女38例;年龄(46.3±12.1)岁;病程(12.4±23.7)个月;均行术前超声检查,14例行超声引导下细针穿刺细胞学检查(FNA),经FNA确诊PTMC 11例(78.6%);13例行患侧甲状腺全切,3例行患侧甲状腺全切+对侧叶大部切除术,31例行双侧甲状腺全切;14例行中央区颈淋巴结清扫术,15例行中央区加颈侧区淋巴结清扫。肿瘤病灶平均长径(0.68±0.23)cm;21例(44.7%)为多发病灶,其中14例(29.8%)为双侧甲状腺多发病灶;中央区淋巴结转移率48.3%(14/29),颈侧区淋巴结转移率53.3%(8/15)。单因素分析显示,肿瘤侵犯包膜与淋巴结转移有关(P=0.035)。8例患者术后发生并发症,其中暂时性甲状旁腺功能不全5例,切口积液1例,暂时性喉返神经损伤1例,暂时性喉上神经损伤1例。结论:甲状腺外科医生需熟悉甲状腺癌超声特点,不建议扩大FNA指征。对于术前超声已提示多发结节、术中探查可疑多发结节或存在高危因素者,手术建议行双侧甲状腺全切。预防性中央组淋巴结清扫结合术中冷冻病理对确定个体化手术方案及指导术后治疗是必要的。
Objective: To investigate the clinicopathological features and diagnosis and treatment strategies of thyroid papillary carcinoma (PTMC). Methods: The clinical data of 47 patients with PTMC confirmed by surgery and pathology from June 2011 to May 2016 were retrospectively analyzed. Results: Among the 47 patients, there were 9 males and 38 females with an average age of (46.3 ± 12.1) years and a duration of (12.4 ± 23.7) months. All patients underwent preoperative ultrasonography and 14 underwent fine needle aspiration cytology (FNA). FNA was confirmed by FNA in 11 cases (78.6%). Thirteen patients underwent total thyroidectomy, three underwent total thyroidectomy plus lateral lobectomy, and 31 underwent bilateral thyroidectomy ; 14 cases of central lymph node dissection, 15 cases of central area plus cervical lymph node dissection. The average length of tumor lesions was (0.68 ± 0.23) cm. Twenty-one patients (44.7%) had multiple lesions. Fourteen patients (29.8%) had bilateral multiple thyroid lesions. The central lymph node metastasis rate was 48.3% (14/29) Lateral lymph node metastasis rate was 53.3% (8/15). Univariate analysis showed that the tumor invasion of the envelope and lymph node metastasis (P = 0.035). Eight patients had postoperative complications, including 5 cases of transient parathyroid insufficiency, 1 case of incisional effusion, 1 case of transient laryngeal nerve injury and 1 case of temporary laryngeal nerve injury. Conclusion: Thyroid surgeons need to be familiar with the characteristics of thyroid cancer ultrasound, it is not recommended to expand the FNA indications. For preoperative ultrasound has prompted multiple nodules, intraoperative exploration suspicious multiple nodules or the presence of high risk factors, surgical recommendations for bilateral thyroidectomy. Preventive central lymph node dissection combined with intraoperative cryopathology is necessary to determine individualized surgical procedures and to guide postoperative treatment.