目的对术后意外甲状腺微小乳头状癌(PIPTMC)的诊治进行探讨。方法回顾性分析2007年1月至2014年12月上海交通大学医学院附属瑞金医院21例和解放军八五医院诊治的13例PIPTMC病人资料。34例病人分组:A组(9例),初次手术仅行单侧甲状腺次全切除术;B组(25例),初次行双侧甲状腺手术。B组又分为:B1组(18例),一侧患甲状腺癌行侧腺叶全切除术+中央区淋巴结清扫术,另一侧行次全切除术后发现PIPTMC;B2组(7例),双侧次全切除术,其中一侧术后证实为PIPTMC。结果 A组和B2组残留甲状腺未见癌组织,中央区淋巴结未见癌转移。B1组12例再次术前B超发现有残留结节者中,5例残留甲状腺发现有微小癌灶,且中央区淋巴结有癌转移,这5例首次病理学检查结果提示非PIPTMC侧为多灶癌;余B1组13例残留甲状腺未发现癌组织,中央区淋巴结未见癌转移。A组术后发生1例(11.1%)暂时性神经麻痹;B组术后发生暂时性神经麻痹4例(16%),暂时性低钙血症6例(24%),永久性低钙血症3例(12%)。结论 PIPTMC者多数情况下可以先观察随访,不必急于再次手术。但对于一侧为甲状腺多灶性乳头状癌,一侧为PIPTMC者,由于存在残留癌灶和中央区淋巴结转移的风险,建议尽早再次彻底手术。 Objective To investigate the diagnosis and treatment of postoperative unwanted thyroid papillary carcinoma (PIPTMC). Methods The data of 13 cases of PIPTMC diagnosed and treated by Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine and People’s Liberation Army 85 Hospital from January 2007 to December 2014 were retrospectively analyzed. Thirty-four patients were divided into group A (n = 9), primary unilateral subtotal thyroidectomy only; group B (n = 25) underwent bilateral thyroid surgery for the first time. Group B was divided into: B1 group (18 cases), one side of thyroid adenocarcinoma resection of lateral lobectomy + central lymph node dissection, the other side subtotal resection was found PIPTMC; B2 group (7 cases) , Bilateral subtotal resection, one of the side confirmed after PIPTMC. Results There was no tumor in residual thyroid in group A and group B2, and no metastasis in central lymph node. In group B1, 12 cases of residual nodules were found in preoperative B-ultrasonography, and 5 cases of residual thyroid were found to have tiny foci, and the central lymph nodes had cancer metastasis. The results of the first pathological examination of 5 cases suggested that non-PIPTMC side was multifocal Cancer; residual B1 group 13 cases of residual thyroid cancer was not found in the central lymph node metastasis. One patient (11.1%) had temporary nerve palsy in group A, four patients (16%) had temporary nerve palsy in group B, six patients (24%) had temporary hypocalcemia, permanent hypocalcemia 3 cases (12%). Conclusion In most cases, PIPTMC patients can observe the follow-up, do not rush to reoperation. However, on the one side of thyroid multifocal papillary carcinoma, one side of PIPTMC, due to the existence of residual cancer and central lymph node metastasis risk, it is recommended as soon as possible once again complete surgery.