CAJ | 학술논문

目的：探讨甲状腺微小癌的临床特点和合理的手术方式。方法对168例甲状腺微小癌进行回顾性分析。结果168例甲状腺微小癌，单发病灶124例（73.8%），多发灶44例（26.2%）。预防性中央区淋巴结清除术68例，中央区淋巴结转移率44.1%（30/68）。中央区淋巴结转移行同侧 III、IV 区淋巴结清除术9例，颈侧区淋巴结转移率77.8%（7/9）。全组病人无声音嘶哑发生，暂时性甲状旁腺损伤发生率23.8%（40/168），术后出血1例。预防性中央区淋巴结清除术术后并发症发生率35.3%（24/68）高于未行中央区淋巴结清除术17.6%（13/74）。在84例行中央区淋巴结清除和改良式淋巴结清除术中，男性组颈部淋巴结转移率84.6%（11/13）高于女性47.9%（34/71），多灶甲状腺微小癌颈淋巴结转移率65.4%（17/26）高于单灶48.3%（28/58）。门诊随诊12~36个月无局部复发及远处转移发生。结论甲状腺微小癌具有多灶性和中央区淋巴结高转移率的特点，预防性中央区淋巴结清除术是必要的，特别是对于男性、多灶性、有包膜侵犯者。如中央区淋巴结查见转移癌建议行同侧 III、IV 区淋巴结清除术或功能性淋巴结清除术。
목적：탐토갑상선미소암적림상특점화합리적수술방식。방법대168례갑상선미소암진행회고성분석。결과168례갑상선미소암，단발병조124례（73.8%），다발조44례（26.2%）。예방성중앙구림파결청제술68례，중앙구림파결전이솔44.1%（30/68）。중앙구림파결전이행동측 III、IV 구림파결청제술9례，경측구림파결전이솔77.8%（7/9）。전조병인무성음시아발생，잠시성갑상방선손상발생솔23.8%（40/168），술후출혈1례。예방성중앙구림파결청제술술후병발증발생솔35.3%（24/68）고우미행중앙구림파결청제술17.6%（13/74）。재84례행중앙구림파결청제화개량식림파결청제술중，남성조경부림파결전이솔84.6%（11/13）고우녀성47.9%（34/71），다조갑상선미소암경림파결전이솔65.4%（17/26）고우단조48.3%（28/58）。문진수진12~36개월무국부복발급원처전이발생。결론갑상선미소암구유다조성화중앙구림파결고전이솔적특점，예방성중앙구림파결청제술시필요적，특별시대우남성、다조성、유포막침범자。여중앙구림파결사견전이암건의행동측 III、IV 구림파결청제술혹공능성림파결청제술。
Objective To research the clinical character and reasonable operation of thyroid microcarcinoma(TMC). Methods 168 pa-tients of TMC were retrospective. Results Within 168 TMC,single lesion was found in 124 patients(73. 8% ),multifocality lesions in 44 pa-tients(26. 1% ). The ratio of central lymph node metastasis was 44. 1%(30 / 68)in the 68 patients of prophylactic central lymph node dissection. 9 patients suffered regional lymph nodes dissection(level III and IV compartment). The ratio of unilateral lymph node metastasis was 77. 8%(7 /9)in this subgruop. All patients did not show vocal cord paralysis. The ratio of temporary parathyroid injury was 23. 8%(40 / 168),1 patient bleeding after operation. The complications of near - total thyroidectomy and prophylactic central lymph node dissection were higher than patients only suffered near - total thyroidectomy( P ﹤ 0. 001). Within 84 patients of CLN dissection and modified radical neck dissection,the ratio of neck lymph node metastasis of male patients(84. 6% )was higher than female patients(47. 9% )( P ﹤ 0. 001). The ratio of neck lymph node metastasis of multifocality lesions(65. 4% )was higher than single lesion(48. 3% )( P ﹤ 0. 001). No recurrence and distant metastasis occurred during follow - up from 12 to 36 months after operations. Conclusion TMC showed a high incidence of multifocality and central lymph node me-tastasis. Prophylactic central lymph node dissection is necessary for TMC,especially for male gender,tumor multifocality,and extrathyroidal ex-tension. These findings suggested regional lymph nodes dissection or functional unilateral neck dissection when central lymph node metastasis.