甲状腺细针穿刺对甲状腺手术疾病谱的影响  

Influence of thyroid fine needle aspiration cytology on disease spectrum of thyroid surgery

作　　者：吴立雪[1,2] 王锐 姜勇[1] 苏学英[1] 李金男[1] WU Lixue;WANG Rui;JIANG Yong;SU Xueying;LI Jinnan(Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, China;Department of Pathology, West China Fourth Hospital, Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院病理科,四川成都610041 [2]四川大学华西第四医院病理科,四川成都610041

出　　处：《西部医学》2022年第7期1002-1005,1010,共5页Medical Journal of West China

基　　金：成都市科技项目(2019-YF05-00324-SN);四川大学华西医院学科卓越发展1.3.5工程临床研究孵化项目资助(2020HXFH024)。

摘　　要：目的 探讨术前甲状腺细针穿刺细胞学(FNAC)检查的开展对甲状腺术后疾病谱构成的影响。方法 收集四川大学华西医院2007年1月~2016年12月甲状腺外科手术病例共11574例,逐年统计甲状腺手术总病例数、术前行细针穿刺细胞学病例数、术中冷冻病例数;根据患者术后病理结果统计各年份良恶性病变的占比、恶性肿瘤的具体类型(包括微小乳头状癌)及构成,并对其与术前细针穿刺细胞学检查开展的相关性进行分析。结果 术前细针穿刺率由2.24%增长到了72.30%、术中冷冻率由85.39%降低到了47.50%、术后恶性肿瘤占比由25.93%增长到了83.86%;恶性肿瘤中乳头状癌由86.21%增长到97.53%(其中微小乳头状癌由21.33%增长到了47.64%),髓样癌由2.87%降低到1.21%,滤泡癌由7.47%降低到0.57%,未/低分化癌十年诊断共计28例。结论 甲状腺细针穿刺细胞学的开展能显著提高甲状腺手术恶性肿瘤的占比,极大的改变了恶性肿瘤的构成,减轻了术中冷冻的压力,可在临床大力推广。Objective To investigate the influence of preoperative thyroid fine needle aspiration cytology(FNAC)on the category of thyroid diseases after surgery.Methods This study included 11574 thyroid surgery cases in West China Hospital from 2007 to 2016.The total number of thyroid surgery cases,preoperative FNAC cases and intraoperative freezing cases were calculated year by year.According to the postoperative pathology,the proportion of benign and malignant lesions and the proportion of different malignant types,including papillary thyroid microcarcinoma(PMTC)were also calculated per year.The association between the development of FNAC and the percentage of malignant types changes were also calculated.Results The percentage of preoperative FNAC increased from 2.24%to 72.30%with the decrease of intraoperative freezing rate from 85.39%to 47.50%.The proportion of postoperative malignant tumors increased from 25.93%to 83.86%,with papillary thyroid carcinoma(PTC)increased from 86.21%to 97.53%and PMTC increased from 21.33%to 47.64%.Moreover,medullary cancer decreased from 2.87%to 1.21%and follicular cancer decreased from 7.47%to 0.57%.The undifferentiated/poorly differentiated cancers were only 28 cases during ten years.Conclusion The percentage of malignant thyroid tumors was significantly increased with the development of thyroid FNAC,which greatly changed the composition of malignant tumors and reduced the pressure of intraoperative freezing.Therefore,we concluded that FNAC before surgery was worth promotion in the future clinical practice.

关 键 词：甲状腺 手术 疾病谱 细针穿刺 细胞学 

分 类 号：R365[医药卫生—病理学]