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目的:总结141例甲状腺微小癌(thyroid microcarcinoma,TMC)的诊治经验。方法:回顾性分析1985-06-2006-09我们收治的141例TMC患者的临床病理资料。结果:其临床表现大多为症状不典型、病灶小和隐匿。141例TMC均经手术治疗,其中患侧腺叶近全切除术26例(18.4%),患侧腺叶全部加对侧次全切除术81例(57.4%),全甲状腺切除术34例(24.1%),其中加颈部区域性淋巴结清除14例(10.0%)及加功能性淋巴结清除6例(4.3%)。手术切除率100%,无手术死亡。71例(50.4%)术后随访1～13年,1例局部复发,1例术后12年因肺脏转移死亡。12例行免疫组化检查,11例(91.7%)细胞角蛋白19(CK19)阳性。结论:手术是治疗TMC的唯一有效方法,配合CK19等免疫标志检查可提高TMC的病理诊断正确率。
Objective: To summarize the diagnosis and treatment of 141 cases of thyroid microcarcinoma (TMC). Methods: The clinical and pathological data of 141 patients with TMC from 1985 to 2006 were retrospectively analyzed. Results: Most of the clinical manifestations of atypical symptoms, lesser and hidden. Totally 141 cases of TMC were surgically treated, including 26 cases (18.4%) of resection of ipsilateral pancreas, 81 cases (57.4%) of all the resected lobes of the affected side and 34 cases of total thyroidectomy 24.1%). There were 14 cases (10.0%) with regional neck lymph node dissection and 6 cases (4.3%) with functional lymph node dissection. Surgical resection rate of 100%, no operative death. 71 cases (50.4%) were followed up for 1 ~ 13 years. One case had local recurrence and one case died of pulmonary metastasis 12 years after operation. 12 cases were immunohistochemically examined, and 11 cases (91.7%) were positive for cytokeratin 19 (CK19). Conclusion: Surgery is the only effective method for the treatment of TMC. Combined with CK19 and other immune markers can improve the diagnostic accuracy of TMC.