术中冰冻在BethesdaⅥ类甲状腺结节患者手术方式选择中的价值  

Value of Frozen Section in the Selection of Surgical Modalities for Patients With BethesdaⅥThyroid Nodules

作　　者：骆鹏飞[1] 王雨 Luo Pengfei;Wang Yu(Department of General Surgery,Fuyang People’s Hospital,Fuyang 236000,China;不详)

机构地区：[1]阜阳市人民医院普外科,阜阳236000 [2]安徽医科大学第二临床学院,合肥230032

出　　处：《中国微创外科杂志》2025年第2期70-74,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：安徽省阜阳市自筹经费科技计划项目(FK202081015);安徽省阜阳市卫生健康委科研项目(FY2021-014)。

摘　　要：目的探讨术中冰冻在BethesdaⅥ类甲状腺结节患者手术方式选择的价值。方法回顾分析2022年1月~2024年4月我科287例306枚BethesdaⅥ类甲状腺结节的临床资料,观察术中冰冻改变患者预期手术方式的比例,术前细针穿刺(fine needle aspiration,FNA)和术中冰冻的灵敏度、漏诊率、诊断准确性,以及术中冰冻的使用率和手术医生对于术中冰冻使用的偏好。结果术中冰冻使用率为62.4%(191/306),8位手术医生术中冰冻使用率差异有统计学意义(χ^(2)=36.722,P=0.000)。术中冰冻改变了4.7%(9/191)结节患者的预期手术方式,石蜡病理证实这些改变都是不恰当的。FNA漏诊率显著低于术中冰冻(0.0%vs.4.7%,P=0.000),灵敏度(100.0%vs.95.3%)和诊断准确性(100.0%vs.95.3%)显著高于术中冰冻(P=0.000,0.000)。结论不建议对BethesdaⅥ类甲状腺结节根据术中冰冻再次确认FNA的恶性结果,因为术中冰冻会误导手术医生对部分患者的手术决策。Objective To explore the value of frozen section(FS)in the selection of surgical modalities for patients with BethesdaⅥthyroid nodules.Methods Clinical data of 287 cases of 306 BethesdaⅥthyroid nodules in our department from January 2022 to April 2024 were reviewed.The proportion of changes in patients’expected surgical methods caused by FS,the sensitivity,missed diagnosis rate,and diagnostic accuracy of fine needle aspiration(FNA)and FS,as well as the utilization rate of FS and the preference of surgeons,were observed.Results The utilization rate of FS was 62.4%(191/306),and the difference in utilization rate of FS among 8 surgeons was statistically significant(χ^(2)=36.722,P=0.000).FS changed the expected surgical plan in 4.7%(9/191)of patients with nodules,which was finally proved by paraffin pathology to be inappropriate.The missed diagnosis rate of FNA was significantly lower than that of FS(0.0%vs.4.7%,P=0.000),and the sensitivity(100.0%vs.95.3%)and diagnostic accuracy(100.0%vs.95.3%)of FNA were significantly higher than that of FS(P=0.000 and 0.000).Conclusion It is not recommended to use FS to reconfirm the malignant outcome of FNA for BethesdaⅥthyroid nodules,as FS may mislead surgical decisions in some patients.

关 键 词：甲状腺结节 细针穿刺 术中冰冻 Bethesda分类 

分 类 号：R653[医药卫生—外科学]