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目的探讨临床高度怀疑甲状腺癌而术中冰冻切片不能确诊的甲状腺癌的诊断和治疗对策。方法 回顾分析我院 19例临床高度怀疑甲状腺癌而术中冰冻切片阴性的临床资料。结果 术中冰冻切片不能确诊的甲状腺癌 19例 ,术后石蜡切片证实为癌。其中 3例行一期患叶全切 +峡部切除术 ,1例加同侧颈前淋巴结清扫术。二期患叶全切 +峡部切除 +对侧甲状腺次全切除术 13例。双侧甲状腺全切 +峡部切除术 2例。全组淋巴结清扫 5例。随访 :2例术后 1～ 2年复发而行第三次手术 ,1例术后 5年死于心衰 ,余无复发转移。一期和二期手术的并发症有显著性差异。结论 具有高危因素而冰冻切片不能确诊的甲状腺癌行一期患叶全切 +峡部切除术是较为理想的选择 ,并可减少并发症的发生。
Objective To investigate the diagnosis and treatment of thyroid cancer with high suspicion of thyroid cancer and intraoperative frozen section which can not be diagnosed. Methods A retrospective analysis of 19 cases of our hospital highly suspected thyroid cancer and intraoperative frozen section negative clinical data. Results 19 cases of thyroid cancer could not be diagnosed by intraoperative frozen section, and confirmed by paraffin section after operation. One of three cases underwent total lobectomy and isthmus resection, and one case of ipsilateral anterior cervical lymph node dissection. Two cases of total lobectomy + isthmic resection + contralateral thyroidectomy in 13 cases. Double total thyroidectomy + isthmic resection in 2 cases. The whole group of lymph node dissection in 5 cases. Follow-up: The second operation was performed in 2 cases 1 to 2 years after operation, and 1 case died of heart failure 5 years after operation. Complications of stage I and stage II surgery were significantly different. Conclusion Thyroid cancer with high-risk factors and frozen section can not be diagnosed is the ideal choice for total thyroidectomy and isthmus resection, and can reduce the incidence of complications.