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目的探讨结节性甲状腺肿合并甲状腺微小癌的临床特征、诊断、治疗原则及预后。方法回顾分析2003年1月至2010年2月期间在我科手术治疗的34例结节性甲状腺肿合并甲状腺微小癌患者的临床资料。结果病理诊断乳头状癌33例,滤泡状癌1例。行患侧叶全切除术+峡部切除术+对侧叶次全切除术+患侧中央区淋巴结清扫术3例,1例加行患侧改良性颈部淋巴结清扫术;患侧叶全切除术+峡部切除术+对侧叶次全切除术22例;患侧叶全切除术+峡部切除术1例;甲状腺全切除术8例。2例患者出现术后低钙血症,1周后恢复正常,无其他手术相关并发症发生。随访3个月至5年(平均20.2个月),无一例复发或死亡。结论甲状腺多发结节有恶性的可能,B超有助于诊断。手术方法多为患侧叶全切除术+峡部切除术+对侧叶次全切除术,预后较好。
Objective To investigate the clinical features, diagnosis, treatment principles and prognosis of nodular goiter complicated with thyroid microcarcinoma. Methods The clinical data of 34 patients with nodular goiter complicated with thyroid microcarcinoma surgically treated in our department from January 2003 to February 2010 were retrospectively analyzed. Results Pathological diagnosis of papillary carcinoma in 33 cases, follicular carcinoma in 1 case. 3 cases underwent ipsilateral total lobectomy + isthmus + contralateral lobectomy + ipsilateral central lymph node dissection, 1 case was treated with modified neck lymph node dissection; ipsilateral total lobectomy + Isthmicctomy + contralateral subtotal total resection in 22 cases; ipsilateral total lobectomy + isthmicctomy in 1 case; thyroidectomy in 8 cases. Two patients developed postoperative hypocalcemia and returned to normal one week later without other complications related to surgery. All the patients were followed up for 3 months to 5 years (average 20.2 months) without any recurrence or death. Conclusions Thyroid multiple nodules may be malignant, B-ultrasound can help diagnose. Surgical methods are mostly ipsilateral total lobectomy + isthmic resection + contralateral subtotal total resection, the prognosis is good.