结节性甲状腺肿合并甲状腺微小癌102例临床研究

目的探讨结节性甲状腺肿合并甲状腺微小癌的临床特征及诊断治疗方法。方法自1995年1月至2005年1月期间在本科共手术治疗了2760例结节性甲状腺肿病人，其中合并甲状腺微小癌102例（102／2760，3．70％），对该102例病人临床资料进行回顾性研究。结果102例结节性甲状腺肿合并甲状腺微小癌病人中男36例，女66例，年龄22～69岁，平均年龄42岁。术前检查均未发现有颈部淋巴结肿大，术中快速冰冻明确诊断为甲状腺微小癌76例（74．51％），所有病例均经术后常规病理明确为甲状腺微小癌。术后随访2，10年（平均7．8年），有2例（1．96％）患者术后复发，再次手术治愈。结论结节性甲状腺肿合并甲状腺微小癌预后良好，多数因甲状腺良性病变手术时或术后偶然发现。术中证实为甲状腺癌者，应行患侧甲状腺叶切除术或加前哨淋巴结活检。而对术后病理证实者，依据病情考虑行扩大切除术；但同样也可以不再行进一步手术，仅行术后密切随访。

Clincal study on nodular goiter combined with thyroid microcarcinoma(TMC) ( 102 cases report)

Objective To characterize the clinicopathological features, diagnosis, and treatment for nodular goiter combined with thyroid （TMC）. Methods A total of 2760 patients with nodular goiter who underwent surgical excision at JinHua municipal central hospital between January 1995 and January 2005 were included in current study series, in which 102 cases （3.70%） were found to harbor TMC. Clinical and histological features were reviewed . Results In all 102 cases of nodular goiter combined with thyroid microcareinoma（TMC）, there were 36 males and 66 females with a female predominance. The median age was 42 years （range from 22 to 29 years）. No patient had an enlarged cervical lymph nodes preoperatively. All of the 102 cases of TMC were confirmed postoperatively by pathologic examination, among which 76 cases were identified intraoperatively by cryosecion. At a median follow - up of 7.8 years（ 1 - 10 years）, 2 patients recurred and remain alive with disease . Conclusions The vast majority of nodular goiter combined with thyroid （TMC） has favorable prognosis. Most of them were discovered incidentally during or after benign thyroid disease operations. For the patients with TMC who were discovered intraoperatively, the unilateral lobectomy with or without sentinel lymph node biopsy should be adequate, whereas for those confirmed postoperatively, the complete thyroidectomy may be reasonable, alternatively, watchful follow- up without further operation may also be advisable.