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目的探讨甲状腺微小癌临床漏诊原因及对策。方法分析 1985年 1月至 2 0 0 0年 12月经手术和病理证实的甲状腺微小癌 110例的诊断和治疗资料。结果术前拟诊 2 6例 ,B超诊断阳性率 5 8% (15 / 2 6 ) ,术中冰冻诊断阳性率 6 7% (14 / 2 1)。术中拟诊 30例 ,冰冻切片诊断阳性率 80 %(2 4 / 30 )。术后病理检查确诊微小癌 5 4例 ,其中 19例术中冰冻未发现微小癌。仅 35例行全甲状腺或次全甲状腺切除 ,其余行一侧叶或双侧叶的甲状腺切除术。随访率 80 1% ,随访时间 6月至 15年。 1例复发 ,无一例死亡。结论甲状腺微小癌临床漏诊率较高。术前仔细的触诊 ,B超结合细针穿刺抽吸细胞学检查 (FNAC)和术中认真探查可疑结节有助于提高临床诊断率。甲状腺叶的全切除或次全切除治疗甲状腺微小癌具有良好的临床疗效
Objective To investigate the causes and countermeasures of missed diagnosis of thyroid microcarcinoma. Methods The data of diagnosis and treatment of 110 cases of thyroid microcarcinoma proved surgically and pathologically from January 1985 to December 2000 were analyzed. Results 26 cases were diagnosed preoperatively and the positive rate of B ultrasound diagnosis was 58% (15/26). The positive rate of intraoperative frozen diagnosis was 67% (14/21). Intraoperative diagnosis of 30 cases, frozen section diagnosis of positive rate of 80% (24/30). Postoperative pathological examination diagnosed 54 cases of micro-cancer, of which 19 cases of intraoperative frozen found no micro-cancer. Only 35 cases of total thyroid or subtotal thyroidectomy, the remaining line of one or both leaves of the thyroid surgery. Follow-up rate 80 1%, follow-up time from June to 15 years. 1 case of recurrence, no case of death. Conclusion The clinical diagnosis rate of thyroid microcarcinoma is high. Preoperative careful palpation, B-ultrasonography combined with fine needle aspiration cytology (FNAC) and intraoperative careful detection of suspicious nodules will help to improve the clinical diagnosis rate. Total thyroidectomy or subtotal resection of thyroid microcarcinoma has good clinical efficacy