隐匿性甲状腺癌的探讨  

STUDY ON OCCULT CARCINOMA OF THYROID

作　　者：芦艳艳[1] 

机构地区：[1]临沂市中医医院,山东临沂276002

出　　处：《山东医学高等专科学校学报》2009年第3期183-185,共3页Journal of Shandong Medical College

摘　　要：目的探讨隐匿性甲状腺癌的发病及淋巴结转移特点、诊断和治疗选择。方法回顾性分析手术治疗34例隐匿性甲状腺癌的临床和病理资料。结果以甲状腺肿块首发症状26例(76.5%),其中14例行腺叶切除术;以颈淋巴结肿大为首发症状8例(23.5%),均行腺叶切除并颈淋巴结清除术。术前诊断率60.1%(22/66),淋巴结转移率30.6%(11/36)。30例平均随访7.4年,5年、10年生存率为100%(16/16)、87.5%(7/8)。2例分别于术后2年、3年复发,1例术后6.5年死于远处转移。结论隐匿性甲状腺癌转移与病理类型有关,与原发灶大小无关。单发或多发结节细针穿刺及术中冰冻切片检查可提高诊断率。首次腺叶切除术后病理发现癌灶侵犯包膜或淋巴结阳性者应行Ⅱ期根治并颈淋巴结清扫术。无淋巴结转移者病灶侧腺叶切除已足够,伴颈淋巴结转移者需加行颈淋巴结清扫术。Objective To explore the characteristics of clincopathologic and lymphogenous metastasis,the diagnosis and the treatment of occult carcinoma of thyroid(OCT).Methods The clinical and pathological data of 36 cases of OCT with surgery were observed and analyzed retrospectively.Results 26cases(76.5%) of them were found with primary symptoms of thyroid mass.Unilateral lobectomy with neck dissection was performed.The diagnosis rate was 60.1%(22/36),and the metastasis rate of lymph node was 30.6%(11/36) by pathology.Median follow-up survey time was 7.4 years in 32 cases.The survival rate of 5 and 10 years was100%(16/16) and 87.5%(7/8) respectively.Among the follow-up cases,2 case got recurrence in 2 and 3 years respectively,and one case died of distant metastasis.Conclusion Metastasis of OCT is associated with the pathological type but with the size of primary lesion.The diagnosis rate cab be increased by FNAC of mass and frozen section during operation.The further radical dissection should be performed for the cases with infusion of the thyroid capsule or the positive cervical lymph nodes by pathology after first operation.For patients without cervical metastases,unilateral lobectomy is sufficient,and for patients with cervical metastases neck dissection must be added up.

关 键 词：甲状腺 隐匿癌 颈淋巴结转移 手术 

分 类 号：R736.1[医药卫生—肿瘤] R735.35[医药卫生—临床医学]