摘要
目的探讨甲状腺乳头状微小癌的临床特征、诊断及治疗方式。方法回顾性分析1985～ 2 0 0 2年间我院收治并经病理证实的甲状腺乳头状微小癌 89例患者的临床资料。结果随访 89例 ,时间 5～ 196个月 ,平均 6 8 9个月。复发 5例 ,无死亡 ,未发现远处转移。因甲状腺良性病变手术而发现微小癌 38例 ,另 5 1例术前怀疑为癌 ,经活检发现微小癌。颈部淋巴结转移 4 0例 ,最多发生在颈深上、中组和气管食管沟组淋巴结。腺叶多发结节转移的发生率显著高于单发结节。不同大小的原发肿瘤 (≤ 5mm ;>5mm)在颈部淋巴结转移的发生率其差异有显著性。是否可触及肿大淋巴结对局部复发率的影响差异有显著性。结论术前触诊、B超检查、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。根据病情选择不同的切除范围 ,疗效是同样的。建议区分两类甲状腺乳头状微小癌 :一类良性进展 ,应以保守性手术为主 ;另一类侵袭性进展 ,有不良预后 ,应行积极的手术方式。
Objective To investigate the biological behavior, clinical characteristics, diagnosis and therapy of papillary thyroid microcarcinoma(PTMC). Methods The clinical data of 89 cases with PTMC treated and confirmed by pathology from 1985 to 2002 were retrospectively analyzed. Results All patients were followed-up from 5 to 196 (mean 68.9) months. Five cases suffered recurrence and are alive. PTMC was found in 38 cases incidentally from thyroid specimens removed for supposed benign disease, another 51 cases were doubtful of cancer before operation and were identified by biopsy. Upper and mid deep cervical lymph nodes and tracheoesophageal fold lymph node were more commonly involved in 40 cases with lymph node metastasis. The frequency of lymph node metastasis among primary tumor in upper third, middle third and lower third lobe were not different significantly. Lymph node metastasis in cases of multifocal cancer in the affected lobe or of both lobes was significantly higher than in monofocal cancer in uni-lobe. The primary tumor size(≤5 mm,>5 mm) had a significant influence on the frequency and distribution of cervical lymph node metastasis. The local recurrent rate in palpable lymph node group was significantly higher than the non-palpable lymph node group. Conclusions Careful palpation, B type ultrasonography, exploratory operation and frozen section are very important factors to heighten diagnosis of PTMC. We believe that PTMC could be divided into two subsets: with the former of non-aggressive behaviors treated by conservative surgery, and the later of a potentially aggressive clinical course treated by a more aggressive procedure.
出处
《中华普通外科杂志》
CSCD
北大核心
2004年第4期242-244,共3页
Chinese Journal of General Surgery
关键词
甲状腺乳头状微小癌
临床特征
诊断
治疗
生物学行为
Thyroid neoplasm
Surgical procedure, operative
Microcarcinoma
Biological behavior
