Clinical Study of 34 Cases Patients of Nodular Goiter with Thyroid Microcarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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徐晓波 , 刘文勇

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甲状腺肿瘤; 结节性甲状腺肿; 微小癌; 治疗; 手术

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目的探讨结节性甲状腺肿合并甲状腺微小癌的临床特征、诊断、治疗原则及预后。方法回顾分析2003年1月至2010年2月期间在我科手术治疗的34例结节性甲状腺肿合并甲状腺微小癌患者的临床资料。结果病理诊断乳头状癌33例，滤泡状癌1例。行患侧叶全切除术+峡部切除术+对侧叶次全切除术+患侧中央区淋巴结清扫术3例，1例加行患侧改良性颈部淋巴结清扫术; 患侧叶全切除术+峡部切除术+对侧叶次全切除术22例; 患侧叶全切除术+峡部切除术1例; 甲状腺全切除术8例。2例患者出现术后低钙血症，1周后恢复正常，无其他手术相关并发症发生。随访3个月至5年(平均20.2个月)，无一例复发或死亡。结论甲状腺多发结节有恶性的可能，B超有助于诊断。手术方法多为患侧叶全切除术+峡部切除术+对侧叶次全切除术，预后较好。

Citation： 徐晓波,刘文勇. Clinical Study of 34 Cases Patients of Nodular Goiter with Thyroid Microcarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(2): 196-197. doi: Copy

1.	Lim DJ, Baek KH, Lee YS, et al. Clinical, histopathological, and molecular characteristics of papillary thyroid microcarcinoma [J].Thyroid, 2007, 17(9): 883888.
2.	马峻峰, 唐波, 李铁汉, 等. 促甲状腺激素抑制疗法在分化型甲状腺癌治疗中的作用 [J]. 中国普外基础与临床杂志, 2009, 16(5): 348350.
3.	Baudin E, Travagli JP, Ropers J, et al. Microcarcinoma of the thyrroid gland: the GustaveRoussy Institute experience [J]. Cancer, 1998, 83(3): 553559.
4.	Park YJ, Kim YA, Lee YJ, et al. Papillary microcarcinoma in comparison with larger papillary thyroid carcinoma in BRAF(V600E) mutation, clinicopathological features, and immunohistochemical findings [J]. Head Neck, 2010, 32(1): 3845.
5.	季正标, 张晖, 俞清, 等. 灰阶及彩色多普勒血流成像在甲状腺癌诊断中的应用 [J]. 中国医学影像技术, 2002, 18(7): 554556.
6.	陈皓. 结节性甲状腺肿合并乳头状微小癌的彩色超声诊断分析 [J]. 当代医学, 2009, 15(6): 135.
7.	赵艳侠, 杜红丽. 钙化在甲状腺结节良恶性鉴别诊断中的价值200例分析 [J]. 中国误诊学杂志, 2009, 9(31): 76837684.
8.	周文斌, 周冬仙, 麦沛成, 等. 结节性甲状腺肿并存甲状腺微小癌: 54例报告 [J]. 中国现代医学杂志, 2009, 19(22): 34703472.
9.	盖宝东, 郑泽霖, 张德恒, 等. 169例结节性甲状腺肿与甲状腺癌并存的诊治体会 [J]. 中国普外基础与临床杂志, 2004, 11(6): 496497.
10.	Gurleyik E, Coskun O, Aslaner A. Clinical importance of solitary solid nodule of the thyroid in endemic goiter region [J]. Indian J Med Sci, 2005, 59(9): 388395.
11.	武阿丽, 许长起, 任玉波. 结节性甲状腺肿合并甲状腺乳头状微小癌18例病理分析 [J]. 肿瘤基础与临床, 2009, 22(3): 259260.
12.	Pelizzo MR, Boschin IM, Toniato A, et al. Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients [J]. Eur J Surg Oncol, 2006, 32(10): 11441148.
13.	National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. V. 1. 2010 [EB/OL]. http://www.nccn.org/professionals/physcian_gls/PDF/thyroid.
14.	Besic N, Pilko G, Petric R, et al. Papillary thyroid microcarcinoma: prognostic factors and treatment [J]. J Surg Oncol, 2008, 97(3): 221225.
15.	Giordano D, Gradoni P, Oretti G, et al. Treatment and prognostic factors of papillary thyroid microcarcinoma [J]. Clin Otolaryngol, 2010, 35(2): 118124.

1. Lim DJ, Baek KH, Lee YS, et al. Clinical, histopathological, and molecular characteristics of papillary thyroid microcarcinoma [J].Thyroid, 2007, 17(9): 883888.
2. 马峻峰, 唐波, 李铁汉, 等. 促甲状腺激素抑制疗法在分化型甲状腺癌治疗中的作用 [J]. 中国普外基础与临床杂志, 2009, 16(5): 348350.
3. Baudin E, Travagli JP, Ropers J, et al. Microcarcinoma of the thyrroid gland: the GustaveRoussy Institute experience [J]. Cancer, 1998, 83(3): 553559.
4. Park YJ, Kim YA, Lee YJ, et al. Papillary microcarcinoma in comparison with larger papillary thyroid carcinoma in BRAF(V600E) mutation, clinicopathological features, and immunohistochemical findings [J]. Head Neck, 2010, 32(1): 3845.
5. 季正标, 张晖, 俞清, 等. 灰阶及彩色多普勒血流成像在甲状腺癌诊断中的应用 [J]. 中国医学影像技术, 2002, 18(7): 554556.
6. 陈皓. 结节性甲状腺肿合并乳头状微小癌的彩色超声诊断分析 [J]. 当代医学, 2009, 15(6): 135.
7. 赵艳侠, 杜红丽. 钙化在甲状腺结节良恶性鉴别诊断中的价值200例分析 [J]. 中国误诊学杂志, 2009, 9(31): 76837684.
8. 周文斌, 周冬仙, 麦沛成, 等. 结节性甲状腺肿并存甲状腺微小癌: 54例报告 [J]. 中国现代医学杂志, 2009, 19(22): 34703472.
9. 盖宝东, 郑泽霖, 张德恒, 等. 169例结节性甲状腺肿与甲状腺癌并存的诊治体会 [J]. 中国普外基础与临床杂志, 2004, 11(6): 496497.
10. Gurleyik E, Coskun O, Aslaner A. Clinical importance of solitary solid nodule of the thyroid in endemic goiter region [J]. Indian J Med Sci, 2005, 59(9): 388395.
11. 武阿丽, 许长起, 任玉波. 结节性甲状腺肿合并甲状腺乳头状微小癌18例病理分析 [J]. 肿瘤基础与临床, 2009, 22(3): 259260.
12. Pelizzo MR, Boschin IM, Toniato A, et al. Papillary thyroid microcarcinoma (PTMC): prognostic factors, management and outcome in 403 patients [J]. Eur J Surg Oncol, 2006, 32(10): 11441148.
13. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Thyroid Carcinoma. V. 1. 2010 [EB/OL]. http://www.nccn.org/professionals/physcian_gls/PDF/thyroid.
14. Besic N, Pilko G, Petric R, et al. Papillary thyroid microcarcinoma: prognostic factors and treatment [J]. J Surg Oncol, 2008, 97(3): 221225.
15. Giordano D, Gradoni P, Oretti G, et al. Treatment and prognostic factors of papillary thyroid microcarcinoma [J]. Clin Otolaryngol, 2010, 35(2): 118124.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Study of 34 Cases Patients of Nodular Goiter with Thyroid Microcarcinoma

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