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目的探讨结节性甲状腺肿手术意外发现甲状腺微小癌(TMC)的临床病理学特点、诊断及治疗方式选择。方法回顾性分析2004年1月—2010年1月收治的结节性甲状腺肿手术意外发现甲状腺微小癌68例的临床资料。结果患者最大良性结节平均直径为(1.89±0.68)cm。甲状腺微小癌直径为0.1~0.8 cm,平均(0.38±0.14)cm,≤0.5 cm者43例(63.24%)。6例(8.82%)为多发病灶(1~4个),62例(91.18%)为单发病灶。47例(69.12%)术中快速冷冻切片报告为甲状腺微小癌,随即加做中央区淋巴结清扫术;其余21例(30.88%)术中快速冷冻切片漏诊,术后病理切片确诊,未追加淋巴结清扫术。术后随访12~84个月,平均(52.47±13.26)个月,未发现复发转移病例。结论结节性甲状腺肿手术意外发现甲状腺微小癌临床常见,术前诊断困难,但预后较好。为避免复发及漏诊TMC,结节性甲状腺肿的手术适应证应适当放宽,切除范围应适当扩大。
Objective To investigate the clinicopathological features, diagnosis and treatment options of thyroid microcarcinoma (TMC) discovered by unexpected operation of nodular goiter. Methods The clinical data of 68 cases of thyroid microcarcinoma accidentally found in nodular goiter admitted from January 2004 to January 2010 were retrospectively analyzed. Results The average diameter of the largest benign nodules was (1.89 ± 0.68) cm. Thyroid microcarcinoma diameter of 0.1 ~ 0.8 cm, with an average (0.38 ± 0.14) cm, ≤0.5 cm in 43 cases (63.24%). 6 cases (8.82%) were multiple lesions (1-4), and 62 cases (91.18%) were single lesions. Forty-seven patients (69.12%) had intra-operative fast frozen sections, which were reported as thyroid microcarcinoma, followed by central lymph node dissection. The remaining 21 cases (30.88%) were misdiagnosed as intraoperative frozen sections and were confirmed by pathological examination without additional lymph node dissection Surgery. The patients were followed up for 12-84 months (mean 52.47 ± 13.26) months, and no recurrence and metastasis was found. Conclusions Nodular goiter accidentally found that thyroid microcarcinoma is a common clinical symptom. It is difficult to diagnose before surgery, but the prognosis is good. To avoid recurrence and missed diagnosis of TMC, nodular goiter indications should be appropriately relaxed, resection should be appropriately expanded.