论文部分内容阅读
目的探讨甲状腺微小癌(TMC)的治疗选择。方法回顾性分析哈尔滨医科大学附属第一医院2002年1月至2007年1月收治的141例TMC的临床资料。根据病人不同的确诊过程选择不同的手术方式进行治疗,分析其疗效,并对淋巴结转移的影响因素进行了分析。结果术前或术中确诊的117例病人根据不同情况行患侧腺叶全切+峡部切除+对侧腺叶次全切或双侧腺叶全/近全/次全切除术,术后仅4例复发(3.4%)。术前和术中均诊断为甲状腺良性疾病,而术后病理连续切片才偶然发现的24例TMC中,21例由于无淋巴结转移且已行患侧次全切除术,未发现包膜和血管受侵犯,切除组织边缘无癌细胞浸润,病灶为单发,因此未行二次手术扩大切除范围,无一例复发。颈部淋巴结肿大的27例病人行淋巴结清扫,其中3例复发,复发率为11.1%,而未行淋巴结清扫的114例病人有2例复发,复发率仅为1.8%,显著低于前者(P<0.05)。结论对TMC应采用个体化治疗方案,根据不同类型的病例采取不同的手术方式和治疗策略。TMC有一定的淋巴结转移率,多发病灶、有包膜浸润、直径≥5mm是影响淋巴结转移的重要因素。出现颈部淋巴结肿大的病人应行淋巴结清扫术,但对无淋巴结肿大者不必进行预防性淋巴结清扫。
Objective To investigate the treatment of thyroid microcarcinoma (TMC). Methods The clinical data of 141 TMC patients admitted to the First Affiliated Hospital of Harbin Medical University from January 2002 to January 2007 were retrospectively analyzed. According to the patient’s different diagnosis process choose different surgical methods for treatment, analysis of its efficacy, and lymph node metastasis factors were analyzed. Results 117 patients diagnosed preoperatively or intraoperatively underwent ipsilateral total lobectomy, isthmus resection, subtotal lobectomy or bilateral total lobectomy, and only Four patients relapsed (3.4%). Preoperative and intraoperative diagnosis of benign thyroid disease, and pathological serial sections after 24 occasional TMC was found in 21 cases due to no lymph node metastasis and subtotal subtotal resection, found no capsule and vascular receptors Invasion, removal of tissue edge cancer cell infiltration, the lesion is single, so no second surgery to expand the scope of resection, no case of recurrence. Twenty-seven patients with cervical lymph node enlargement underwent lymph node dissection, of which 3 patients relapsed with a recurrence rate of 11.1%. Out of 114 patients without lymph node dissection, 2 patients relapsed with a recurrence rate of 1.8%, significantly lower than the former P <0.05). Conclusion TMC should be individualized treatment programs, according to different types of cases to take different surgical methods and treatment strategies. TMC has a certain degree of lymph node metastasis, multiple lesions, enveloped infiltration, diameter ≥ 5mm is an important factor affecting lymph node metastasis. Lymphadenopathy occurs in patients with lymph node dissection should be performed, but no lymphadenopathy without preventive lymph node dissection.