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目的探讨并存于良性疾病中的甲状腺微小癌的病理特征及外科治疗方法。方法回顾性分析20例因甲状腺良性疾病行手术治疗而检出甲状腺微小癌的患者临床病理资料和手术方式。结果400例因甲状腺良性疾病行手术治疗的患者共检出甲状腺微小癌20例(5%)。20例中2例(10%)于术中冰冻病理检查确诊,18例(90%)于术后连续病理切片确诊;乳头状癌19例(95%),髓样癌1例(5%);2例浸润或浸透包膜(10%),2例有砂粒体(10%),无血管内癌栓和颈淋巴结转移病例。20例中行甲状腺近全切除术3例(15%),双侧甲状腺次全切除术13例(65%),患侧叶次全切除术4例(20%)。全部病例无并发症发生。术后随访45~60个月,无局部复发及颈淋巴结和远处转移。结论并存于良性疾病中甲状腺微小癌以乳头状癌多见,淋巴结转移率低;连续病理切片检查可防止微小癌的漏诊;甲状腺近全切除术及双侧甲状腺次全切除术是有效的治疗方法,不需作预防性颈淋巴结清扫术。
Objective To investigate the pathological features and surgical treatment of thyroid microcarcinoma coexisting in benign diseases. Methods A retrospective analysis of 20 cases of thyroid benign diseases underwent surgical treatment of patients with thyroid cancer and clinicopathological data and surgical methods. Results Totally 20 cases (5%) of thyroid microcarcinomas were detected in 400 cases of thyroid benign diseases undergoing surgical treatment. Two cases (10%) were diagnosed by intraoperative frozen pathology and 18 cases (90%) were confirmed by serial pathological examination. Nineteen cases (95%) had papillary carcinoma and one case (5%) had medullary carcinoma ; 2 cases of infiltration or infiltration of the capsule (10%), 2 cases of sand body (10%), no intravascular thrombosis and cervical lymph node metastasis. Twenty patients underwent thyroidectomy in 3 cases (15%), bilateral thyroidectomy in 13 cases (65%) and ipsilateral subtotal lobectomy in 4 cases (20%). No complications occurred in all cases. All patients were followed up for 45-60 months without local recurrence and cervical lymph node metastasis. Conclusions Coexisting with benign thyroid carcinoma is more common in papillary carcinoma and lymph node metastasis in benign diseases. Continuous pathological examination can prevent the missed diagnosis of micro-carcinoma. Thyroidectomy and bilateral subtotal thyroidectomy are effective treatments , No need for preventive cervical lymph node dissection.