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目的:探讨当前甲状腺微小癌(TMC)的诊断及治疗现状,并为进一步规范外科术式的选择提供临床依据。方法:回顾2013年2月—2015年2月间28例手术和病理均证实为TMC患者的临床资料,对其诊断、手术方式及预后等进行分析。结果:28例TMC患者术前彩超检查均发现病灶,15例彩超下细针穿刺确诊者4例(26.7%),术中冷冻切片确诊者27例(96.4%),术后病理确诊者1例(3.6%)。所有患者行手术治疗,包括甲状腺全切除术8例(28.6%)、甲状腺次全切除术7例(25.0%)、甲状腺患侧腺叶+峡部切除术10例(35.7%)、患侧腺叶切除术3例(10.7%)。术后均获随访,无复发、转移或死亡者。结论:TMC的检出率有增高趋势,目前的术前明确诊断仍较为困难,外科手术是主要治疗手段;如何提高术前诊断率与规范化手术治疗已成为当务之急。
Objective: To investigate the current status of diagnosis and treatment of thyroid microcarcinoma (TMC) and to provide a clinical basis for further regulating the choice of surgical procedure. Methods: The clinical data of 28 patients with TMC confirmed by operation and pathology from February 2013 to February 2015 were retrospectively analyzed. The diagnosis, operation method and prognosis were analyzed. Results: Twenty-eight patients with TMC were found preoperative color Doppler ultrasound examination. Four cases (26.7%) were confirmed by color ultrasonography and fine needle aspiration, 27 cases (96.4%) were confirmed by frozen section, one case was pathologically confirmed (3.6%). Surgical treatment of all patients included 8 cases (28.6%) of total thyroidectomy, 7 cases (25.0%) of subtotal thyroidectomy, 10 cases (35.7%) of adenomyosis and isthmus of thyroid gland, Excision in 3 cases (10.7%). All patients were followed up without recurrence, metastasis or death. Conclusion: The detection rate of TMC is increasing. The current diagnosis before surgery is still difficult. Surgery is the main treatment method. How to improve the preoperative diagnosis rate and standard surgical treatment has become a top priority.