山东医学高等专科学校学报
山東醫學高等專科學校學報
산동의학고등전과학교학보
JOURNAL OF SHANDONG MEDICAL COLLEGE
2009年
3期
183-185
,共3页
甲状腺,隐匿癌%颈淋巴结转移%手术
甲狀腺,隱匿癌%頸淋巴結轉移%手術
갑상선,은닉암%경림파결전이%수술
Thyroid gland%Occult carcinoma%Cervical lymph node metastasis%Surgery
目的 探讨隐匿性甲状腺癌的发病及淋巴结转移特点、诊断和治疗选择.方法 回顾性分析手术治疗34例隐匿性甲状腺癌的临床和病理资料.结果 以甲状腺肿块首发症状26例(76.5%),其中14例行腺叶切除术;以颈淋巴结肿大为首发症状 8例(23.5%),均行腺叶切除并颈淋巴结清除术.术前诊断率60.1%(22/66),淋巴结转移率30.6%(11/36).30例平均随访7.4年,5年、10年生存率为100%(16/16)、87.5%(7/8).2例分别于术后2年、3年复发,1例术后6.5年死于远处转移.结论 隐匿性甲状腺癌转移与病理类型有关,与原发灶大小无关.单发或多发结节细针穿刺及术中冰冻切片检查可提高诊断率.首次腺叶切除术后病理发现癌灶侵犯包膜或淋巴结阳性者应行Ⅱ期根治并颈淋巴结清扫术.无淋巴结转移者病灶侧腺叶切除已足够,伴颈淋巴结转移者需加行颈淋巴结清扫术.
目的 探討隱匿性甲狀腺癌的髮病及淋巴結轉移特點、診斷和治療選擇.方法 迴顧性分析手術治療34例隱匿性甲狀腺癌的臨床和病理資料.結果 以甲狀腺腫塊首髮癥狀26例(76.5%),其中14例行腺葉切除術;以頸淋巴結腫大為首髮癥狀 8例(23.5%),均行腺葉切除併頸淋巴結清除術.術前診斷率60.1%(22/66),淋巴結轉移率30.6%(11/36).30例平均隨訪7.4年,5年、10年生存率為100%(16/16)、87.5%(7/8).2例分彆于術後2年、3年複髮,1例術後6.5年死于遠處轉移.結論 隱匿性甲狀腺癌轉移與病理類型有關,與原髮竈大小無關.單髮或多髮結節細針穿刺及術中冰凍切片檢查可提高診斷率.首次腺葉切除術後病理髮現癌竈侵犯包膜或淋巴結暘性者應行Ⅱ期根治併頸淋巴結清掃術.無淋巴結轉移者病竈側腺葉切除已足夠,伴頸淋巴結轉移者需加行頸淋巴結清掃術.
목적 탐토은닉성갑상선암적발병급림파결전이특점、진단화치료선택.방법 회고성분석수술치료34례은닉성갑상선암적림상화병리자료.결과 이갑상선종괴수발증상26례(76.5%),기중14례행선협절제술;이경림파결종대위수발증상 8례(23.5%),균행선협절제병경림파결청제술.술전진단솔60.1%(22/66),림파결전이솔30.6%(11/36).30례평균수방7.4년,5년、10년생존솔위100%(16/16)、87.5%(7/8).2례분별우술후2년、3년복발,1례술후6.5년사우원처전이.결론 은닉성갑상선암전이여병리류형유관,여원발조대소무관.단발혹다발결절세침천자급술중빙동절편검사가제고진단솔.수차선협절제술후병리발현암조침범포막혹림파결양성자응행Ⅱ기근치병경림파결청소술.무림파결전이자병조측선협절제이족구,반경림파결전이자수가행경림파결청소술.
Objective To explore the characteristics of clincopathologic and lymphogenous metastasis,the diagnosis and the treatment of occult carcinoma of thyroid (OCT).Methods The clinical and pathological data of 36 cases of OCT with surgery were observed and analyzed retrospectively.Results 26cases(76.5%) of them were found with primary symptoms of thyroid mass. Unilateral lobectomy with neck dissection was performed. The diagnosis rate was 60.1% (22/36),and the metastasis rate of lymph node was 30.6%(11/36) by pathology. Median follow -up survey time was 7.4 years in 32 cases.The survival rate of 5 and 10 years was100% (16/16) and 87.5%(7/8) respectively. Among the follow -up cases,2 case got recurrence in 2 and 3 years respectively,and one case died of distant metastasis.Conclusion Metastasis of OCT is associated with the pathological type but with the size of primary lesion. The diagnosis rate cab be increased by FNAC of mass and frozen section during operation.The further radical dissection should be performed for the cases with infusion of the thyroid capsule or the positive cervical lymph nodes by pathology after first operation. For patients without cervical metastases,unilateral lobectomy is sufficient,and for patients with cervical metastases neck dissection must be added up.
