弥漫硬化型甲状腺乳头状癌26例诊治分析

doi:10.19538/j.cjps.issn1005-2208.2025.09.13

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (09) : 1032-1035. DOI: 10.19538/j.cjps.issn1005-2208.2025.09.13

论著

弥漫硬化型甲状腺乳头状癌26例诊治分析

何润东，付庆锋，张帅，孙平，孙辉，周乐

作者信息 +

文章历史 +

摘要

目的探讨弥漫硬化型甲状腺乳头状癌（DSVPTC）的诊治要点。方法回顾性分析吉林大学中日联谊医院甲状腺外科2015年1月至2022年9月期间26例DSVPTC病人的一般资料，超声、穿刺细胞学、石蜡病理结果及术后综合治疗方案，并复习相关文献。结果 26例（21/26，80.8%）病人以女性居多，平均年龄31.6岁；均确诊后行手术治疗，其中甲状腺全切除+颈淋巴结（双侧Ⅵ区，双侧Ⅱ、Ⅲ、Ⅳ、Ⅴ区）清扫8例，甲状腺全切除+颈淋巴结（双侧Ⅵ区，单侧Ⅱ、Ⅲ、Ⅳ、Ⅴ区）清扫10例，甲状腺全切除+颈淋巴结（双侧Ⅵ区）清扫1例；单侧腺叶及峡部切除+颈淋巴结（双侧Ⅵ区，单侧Ⅱ、Ⅲ、Ⅳ、Ⅴ区）清扫3例，单侧腺叶及峡部切除+颈淋巴结（双侧Ⅵ区）清扫4例。术后病理显示该组病例有极高的颈部淋巴结转移发生率（中央区为92.3%；侧颈区为76.9%），同时15例病人合并桥本甲状腺炎（HT）（57.7%），另有4例病人合并经典型甲状腺乳头状癌（CPTC）。术后17例病人进一步行131I治疗，所有病人均行内分泌抑制治疗。定期复查随访，随访时间最短4个月，最长88个月，2例病人失访，中位随访时间19个月；随访期内病人均无复发转移。结论 DSVPTC多见于年轻女性，淋巴结转移发生率高，局部影像复杂多变，术前应结合多项检查明确诊断，治疗上需要更为积极的综合方案。

Abstract

To explore the key aspects in the diagnosis and treatment of the diffuse sclerosing variant of papillary thyroid carcinoma (DSVPTC). Methods A retrospective analysis was conducted based on 26 patients with DSVPTC treated at the Department of Thyroid Surgery, Jilin University China-Japan Union Hospital from January 2015 to September 2022. The study encompassed general patient information, ultrasound, fine-needle aspiration cytology, paraffin pathology results, and comprehensive postoperative treatment plans. Relevant literature was also reviewed. Results Among the 26 patients, the majority were females (21/26, 80.8%), with an average age of 31.6 years. All patients underwent surgical treatment after preoperative diagnosis, among which 8 cases underwent total thyroidectomy with lymph node clearance (bilateral Ⅵ region, bilateral Ⅱ, Ⅲ, Ⅳ, V regions), 10 cases underwent total thyroidectomy with lymph node clearance (bilateral Ⅵ region, unilateral Ⅱ, Ⅲ, Ⅳ, V regions), 1 case underwent total thyroidectomy with lymph node clearance (bilateral Ⅵ region), 3 cases underwent unilateral thyroid lobectomy and isthmus resection with lymph node clearance (bilateral Ⅵ region, unilateral Ⅱ, Ⅲ, Ⅳ, V regions), and 4 cases underwent unilateral thyroid lobectomy and isthmus resection with lymph node clearance (bilateral Ⅵ region). Postoperative pathology revealed a significantly high rate of cervical lymph node metastasis in these cases (central region: 92.3%; lateral neck region: 76.9%), and 15 patients of them had concomitant Hashimoto's thyroiditis (57.7%). Additionally, 4 patients were found to have concomitant classical papillary thyroid carcinoma (CPTC). Postoperatively, 17 patients received iodine-131 treatment and all patients underwent endocrine suppression therapy. With regular follow-ups, the minimum follow-up time was 4 months and the maximum was 88 months. Two patients were lost to follow-up, and the median follow-up time was 19 months. There was no recurrence or metastasis during the follow-up period. Conclusion DSVPTC is more common in young females, characterized by a high rate of lymph node metastasis and complex and variable local imaging. Preoperative diagnosis should be made by combining multiple examinations. Treatment requires a more active and comprehensive strategy.

导出引用

何润东, 付庆锋, 张帅, 孙平, 孙辉, 周乐. 弥漫硬化型甲状腺乳头状癌26例诊治分析[J]. 中国实用外科杂志. 2025, 45(09): 1032-1035 https://doi.org/10.19538/j.cjps.issn1005-2208.2025.09.13

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