甲状腺微小癌的诊断和治疗

中文摘要

刺针吸细胞学检查；2例患者行放射性核素扫描；5例患者行CT 检查。

2、所入选的101 例患者均采用外科手术治疗方式。其中行11例单侧腺叶及峡部切除术，双侧甲状腺全切术6例，患侧甲状腺切除并中央区淋巴结清扫54例，双侧甲状腺切除并患侧中央区淋巴结清扫25例，甲状腺改良根治术5例。在淋巴结的清扫方面，84例患者行颈部淋巴结清扫术，其中79例患者行单纯VI区淋巴结清扫术。

3 、所有数据通过spss19.0处理，计量资料应用t检验，计数资料应用X2检验；采用单因素方差分析对年龄、性别有无淋巴转移、肿瘤直径、病灶情况、手术方式、是否侵袭包膜等因素进行分析。P<0.05作为有临床意义的标准。

结果：

1、甲状腺微小癌的超声影像学结果：术前甲状腺结节超声根据Kwak等[1]

提出的TI-RADS分级方法，在本次临床研究的101例甲状腺微小癌患者中，Ⅲ级7例、Ⅳa级 46例、Ⅳb级 32例 、Ⅳc级5例、Ⅴ级5例。其中在Ⅲ级及Ⅳ级中，有83例均行超声引导针吸细胞学检查，符合微小癌诊断的有75例。

2、在本组病例的101例均行术中冰冻病理检查，其中19例在术后病理检查中确诊，假阴性率19%；

3 、本组病例中出现VI区淋巴结转移的占38%（38/101），颈侧区淋巴结转移的占14%（14/101），两组具有显著差异（P<0.05），有统计学意义；

4、在VI区淋巴结清扫中，术前超声检查发现转移为60.00%（30/50）；未发现转移淋巴结为25.00%（8/32），具有统计学意义（P<0.05）；颈侧区淋巴结清扫术中，术前超声检查发现及未发现转移淋巴结分别为63.16%和16.67%，有统计学意义（P<0.05）

5、对影响预后、肿瘤复发的相关因素进行单因素方差分析及多因素Logistic回归分析，最后发现病灶为多发、有包膜以及出现淋巴转移为病人出现术后肿瘤复发的独立相关因素（P<0.05）。

6、本次临床研究中，8例患者手术后出现甲状旁腺功能低下，但在术后3

II

中文摘要

个月内恢复，未出现喉返神经麻痹。 结论：

1、目前高分辨率超声和超声引导针吸细胞学检查是术前诊断甲状腺微小癌的主要手段。

2、甲状腺微小癌的淋巴结转移率高，需要常规行患侧甲状腺全切除+VI区淋巴结清扫或者患侧腺叶加峡部切除。结合病情开展综合个体化治疗。

3、甲状腺微小癌可能早期出现颈部淋巴结转移，所以并不都是早期癌。 关键词：甲状腺微小癌；早期诊断；超声；针吸细胞学；

III

Abstract

Abstract

Background: Thyroid carcinoma is a common malignant tumor. The study shows that the incidence of thyroid carcinoma in China is about 15/100000, but in recent years, the incidence rate is younger and higher. Thyroid Mini carcinoma is a special type of thyroid carcinoma, with a diameter of more than 1cm, which is a special type of thyroid carcinoma. With the development of modern medical technology, high resolution ultrasound and pathological diagnosis and treatment level of technology progress and to report on the diagnosis and treatment of thyroid microcarcinoma increased year by year, but many cases is found accidentally discovered in the intraoperative or postoperative thyroid pathological examination, in the process of clinical diagnosis and treatment of misdiagnosis rate is high. Thyroid microcarcinoma of insidious onset, often coexist with other thyroid diseases, and some lesions in long-term a subclinical state. The tumor behavior is considered to be a benign lesion, but not all thyroid microcarcinoma in static state, may also appear tumor invasion hit growth and lymph node transfer phenomenon, lymphatic metastasis is the major route of metastasis, lymph node metastasis will appear after the clinical manifestations of thyroid microcarcinoma and must then be treated. Previous studies have indicated that the effect of thyroid Mini carcinoma treatment is more ideal, surgical treatment can be completely cured. Therefore, special attention should be paid to the diagnosis and treatment of small thyroid carcinoma, and to reduce the incidence of recurrence and metastasis.

Objective: To retrospectively analyze the clinical characteristics, lymph node metastasis and surgical methods of small thyroid carcinoma patients, and to provide guidance for clinical diagnosis and treatment of thyroid carcinoma.

Methods: a retrospective analysis of 101 cases of thyroid Mini carcinoma in the

IV

Abstract

Department of thyroid surgery, the 1st Affiliated Hospital of Zhengzhou University, from January 2012 to January, and patients with thyroid carcinoma were confirmed by postoperative pathological examination. In terms of gender: 26 cases of male, female 75 cases, in terms of age, age of all the cases were 23-68 between the ages of. The age in 58 cases of patients under the age of 45, 43 cases of patients over 45 years old, average age for 46.39±17.85 years old, in the clinical type, including 53 cases of T1N0M0, t1n1m0 in 47 cases. In the incidence of the disease, 20 cases of bilateral gland disease, 81 cases of unilateral gland disease, in terms of the complications, 101cases of patients with other thyroid benign diseases in 61 cases.

1.The selected 101 cases of patients with small thyroid carcinoma were examined by ultrasonography and fine needle aspiration cytology before operation. 2 patients underwent radionuclide scan and 5 patients underwent CT examination.

2.Surgical treatment was adopted in 101 patients. Among them, 99 cases underwent subtotal thyroidectomy. 2 patients underwent unilateral lobectomy and isthmus resection. In lymph node dissection, 99 cases of patients with cervical lymph node dissection, which 51 cases of patients with pure VI lymph node dissection, 31 cases underwent VI + neck region of lateral lymph node dissection; 5 cases and bilateral lateral neck dissection.

3. All the data by spss19.0 processing, measurement data using t-test, count data using X2 test. The single factor variance analysis of gender, age, lymph node metastasis, tumor size, tumor, surgical approach, invasion envelope and other factors were analyzed. P<0.05 as a standard of clinical significance. Result：

1.Thyroid microcarcinoma of ultrasound imaging studies showed that preoperative ultrasound of thyroid nodules by Kwak et al proposed Ti radsclassification grade 7 cases in grade III, IV A-level 46 cases, IV grade B 32 cases, IV grade C in 5 cases,

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