甲状腺微小癌110例临床漏诊原因及对策  

Microcarcinoma of the thyroid: clinically missed diagnosis and management

作　　者：王深明[1] 常光其[1] 郑小新[1] 叶有强[1] 黄雪玲[1] 

机构地区：[1]中山医科大学附属第一医院甲状腺外科,广州510080

出　　处：《中华普通外科杂志》2002年第7期427-429,共3页Chinese Journal of General Surgery

摘　　要：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。ObjectiveTo investigate the cause of clinically missed diagnosis of thyroid microcarcinoma(TMC) and the management. Methods Clinical diagnostic and therapeutic data of 110 cases with TMC operated and confirmed by pathology from Jan. 1985 to Dec. 2000 were analysed. Results Diagnostic positive rates by ultrasonography and freezing section were respectively 58%(15/26) and 66 7%(14/21) in 26 cases diagnosed preoperatively. Diagnostic positive rate of freezing section was 80%(24/30) in 30 cases discovered intraoperatively. Through postoperative pathologic exam,54 cases were confirmed as TMC that was not discovered in 19 cases by intraoperative freezing section.Total or near total thyroidectomy was only performed on 35 cases,lobectomy of one or both lobes on other cases. Follow up rate was 80 1% with time ranging from 6 months to 15 years. One case recurred without mortality.Conclusion The clinical diagnosis of TMC is often difficult to establish. Careful palpation, ultrasonography with fine needle aspiratiou cytology before operation, and thorough exploration of the suspected nodules in operation will help to heighten the diagnostic rate. Total or near total lobectomy fulfils the eradication of TMC.

关 键 词：甲状腺肿瘤 诊断 甲状腺切除术 漏诊 

分 类 号：R736.1[医药卫生—肿瘤]