术前评估因素在中高危甲状腺微小乳头状癌治疗方式决策中的作用  

Role of preoperative assessment factors for decision-making on treatment modalities in papillary thyroid microcarcinoma with intermediate-and high-risk

作　　者：肖思齐 吴宪吉 沈珂羽 张广[1] XIAO Siqi;WU Xianji;SHEN Keyu;ZHANG Guang(Department of Thyroid Surgery,China-Japan Union Hospital of Jilin University,Jilin Provincial Key Laboratory of Surgical Translational Medicine,Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control,Changchun 130033,P.R.China)

机构地区：[1]吉林大学中日联谊医院甲状腺外科,吉林省外科转化医学重点实验室,吉林省甲状腺疾病防治工程实验室,长春130033

出　　处：《中国普外基础与临床杂志》2023年第5期620-625,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：吉林省教育厅“十三五”科学技术项目(项目编号:JJKH20201055KJ)。

摘　　要：目的探讨中高危甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的术前评估指标在治疗方式决策中的作用。方法收集近年来有关PTMC术前评估因素研究的文献并进行综述。结果中高危PTMC宜选择外科治疗,但目前对于手术切除范围及手术后患者的预后情况仍存在争议。穿刺细胞病理结果恶性是决定手术方案的关键因素。手术时年龄<45岁、男性、高体质量指数患者,高血清促甲状腺激素水平、多灶性与峡部肿瘤,超声下结节内部低回声、钙化、边界不清、形态不规则,以及BRAFV600E、端粒酶逆转录酶基因突变,这些因素均可作为术前评估PTMC的风险因素。结论通过对中高危PTMC术前风险因素的全面了解,能更加精确地术前评估并全面掌握患者的病情,临床医生应根据患者的术前评估情况及结合自身临床经验为患者制定个体化的外科治疗方案。Objective To explore the role of preoperative evaluation indicators for decision-making on treatment modalities in papillary thyroid microcarcinoma(PTMC)with intermediate-and high-risk.Method The recent pertinent literatures on studies of risk factors influencing PTMC were collected and reviewed.Results The surgical treatment was advocated for the PTMC with intermediate-and high-risk.However,the intraoperative surgical resection range and the postoperative prognosis of patients were debated.The malignancy of cell puncture pathology was a key factor in determining the surgical protocol.The patients with less than 45 years old at surgery,male,higher body mass index,higher serum thyrotropin level,and multifocal and isthmic tumors,and nodule internal hypoecho,calcification,unclear boundary,and irregular morphology by ultrasound,as well as mutations in BRAFV600E and telomerase reverse transcriptase gene were the risk factors for preoperative evaluation of PTMC with intermediate-and high-risk.Conclusions According to a comprehensive understanding of preoperative risk factors for PTMC with intermediate-and high-risk,it is convenient to conduct an accurate preoperative evaluation and fully grasp the patients’conditions.Clinicians should formulate individualized surgical treatment plans for patients based on preoperative assessment and their own clinical experiences.

关 键 词：甲状腺微小乳头状癌 术前评估 危险分层 

分 类 号：R736.1[医药卫生—肿瘤]