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目的探讨甲状腺微小癌的诊治经验。方法回顾分析2002年1月-2008年12月深圳大学第一附属医院手术病理证实的65例甲状腺微小癌的临床资料。结果术中冰冻切片确诊55例(84.6%),10例术后石蜡切片确诊。10例术后确诊患者未行二次手术,随访3个月～7年,与其余55例患者比较复发率差异无统计学意义。结论术前触诊、B超检查、术中探查及冰冻组织切片对提高甲状腺微小癌的诊断率非常重要。术中明确诊断的微小癌手术应以患侧腺叶加峡部全切,对侧次全切为宜。术后确诊的微小癌如果已行患侧腺叶次全切或全切,可暂不行二次手术,但应密切观察。有颈淋巴结转移者行功能性颈淋巴结清扫术,对于术前彩超未发现及术中未触及淋巴结肿大的患者,不宜做预防性颈清扫。
Objective To investigate the diagnosis and treatment of thyroid microcarcinoma. Methods The clinical data of 65 cases of thyroid microcarcinoma confirmed by surgical pathology from the First Affiliated Hospital of Shenzhen University from January 2002 to December 2008 were retrospectively analyzed. Results Intraoperative frozen sections were confirmed 55 cases (84.6%), 10 cases were confirmed by paraffin section. Ten patients were diagnosed without postoperative second surgery, followed up for 3 months to 7 years, with the remaining 55 patients no significant difference in the recurrence rate. Conclusion Preoperative palpation, B-ultrasound, intraoperative exploration and frozen tissue sections to improve the diagnosis of thyroid cancer is very important. Surgery to confirm the diagnosis of micro-cancer should be ipsilateral lobectomy plus isthmus, contralateral subtotal resection is appropriate. Micro-diagnosed postoperative cancer if the line has been implemented lobectomy subtotal or total cut, can not be the second surgery, but should be closely observed. Patients with cervical lymph node metastasis line functional lymph node dissection, preoperative ultrasound was not found in patients with intraoperative and enlarged lymph nodes have not been treated, should not do preventive neck dissection.