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目的 探讨甲状腺机能亢进 (甲亢 )合并甲状腺微小癌 (thyroidmicrocarcinoma ,TMC)的外科诊断和治疗。方法 分析 1990年 3月～ 2 0 0 3年 8月期间收治的 2 687例甲亢患者中合并甲状腺微小癌的 18例患者的外科诊断和治疗及其预后。结果 本组甲亢与甲状腺微小癌的并存率为 0 .67% ( 18/2 687)。术前确诊 4例 ,术中明确诊断 10例 ,术后病理确诊 4例。其中 2例患者行第二次手术 ,1例补切患侧残余腺体 ,另 1例除补切患侧残余腺体外并加功能性淋巴结清扫。术后随访 10个月～ 14年 ,3例患者再手术后无复发。结论 甲状腺机能亢进合并甲状腺微小癌术前确诊困难 ,术前应详细触诊 ,甲亢患者合并甲状腺结节者应常规作术中快速冰冻切片检查 ,甲状腺叶全切或次全切对治疗甲亢合并甲状腺微小癌具有良好的临床效果
Objective To investigate the surgical diagnosis and treatment of hyperthyroidism combined with thyroid microcarcinoma (TMC). Methods The surgical diagnosis, treatment and prognosis of 18 patients with thyroid microcarcinoma in 2 687 cases of hyperthyroidism who were treated between March 1990 and August 2003 were analyzed. Results The coexistence of hyperthyroidism and thyroid microcarcinoma in this group was 0.67% (18/2 687). 4 cases were diagnosed preoperatively, 10 cases were diagnosed intraoperatively, and 4 cases were pathologically confirmed after operation. Two of the patients underwent the second operation, one had remnant gland remodeling on the affected side and the other one had remnant gland remodeling plus functional lymph node dissection. All patients were followed up for 10 months to 14 years. No recurrence was found in 3 patients after operation. Conclusions Hyperthyroidism combined with thyroid microcarcinoma is difficult to diagnose before surgery. Palpation should be carefully performed before operation. Hyperthyroid patients with thyroid nodules should be routinely frozen intraoperatively for biopsy and thyroidectomy with thyroidectomy or thyroidectomy Micro-cancer has a good clinical effect