双侧甲状腺微小乳头状癌预测因素及其手术治疗策略  

Predictive factors of Bilateral papillary thyroid microcarcinoma and its surgical treatment

作　　者：王淑倩[1] 吕可真[1] 刘小蕉[1] 傅佩芬[1] 

机构地区：[1]浙江大学医学院附属第一医院胃肠甲状腺乳腺中心,浙江杭州310003

出　　处：《中国实用外科杂志》2013年第S1期34-35,38,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨双侧甲状腺微小乳头状癌的预测因素及其手术治疗策略。方法分析了浙江大学医学院附属第一医院甲状腺乳腺外科2011年1月至2012年6月收治269例甲状腺全切或近全切除的微小乳头状癌(PTMC)临床病理学资料,寻找双侧癌的独立预测因素,并探讨其手术治疗策略。结果肿瘤直径≥5 mm及肿瘤多发病灶和双侧癌显著相关(P<0.05),而肿瘤多发病灶是双侧癌的独立预测因素(OR=2.251)。双侧癌中中央区淋巴结转移为49.1%,行甲状腺全切或近全切除加中央区淋巴结清扫不增加术后并发症的发生风险。结论肿瘤多发病灶是预测双侧微小癌的独立预测因素,双侧微小癌有较高的中央区淋巴结转移率,有经验的甲状腺外科医师在甲状腺全切或近全切除后加做中央区淋巴结清扫是安全必要的。Objective To find out the predictive factors of Bilateral papillary thyroid microcarcinoma and to discuss its rational surgical treatment.Methods The clinicopathological characteristics of 269 PTMCs performed total or near-total thyroidectomy from January 2011 to June 2012 were analyzed.Results There was significantly difference in tumor size≥5mm and multifocal lesions between the two groups(P<0.05). In multivariate analysis, multifocal lesions was the only independent predicting factor of Bilateral PTMC(OR=2.251). The rate of central lymph node metastasis was 49.1% in bilateral group and the central lymph node dissection didn't increase the rate of complicationsConclusion Multifocal lesions was the only independent predicting factor of Bilateral PTMC. Because of the high lymph node metastasis rate, it is safe and necessary to perform central lymph node dissection after total or near-total thyroidectomy by skilled surgeon.

关 键 词：甲状腺微小乳头状癌 双侧 多灶 中央区淋巴结清扫 

分 类 号：R736.1[医药卫生—肿瘤]