Abstract:

Surgical treatment countermeasures of Hashimoto thyroiditis with thyroid microcarcinoma        SUN Hui，LI Fang. Department of Thyroid Surgery， China-Japan Union Hospital of Jilin University；Jilin Provincial Key Laboratory of Surgical Translational Medicine；Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control，Changchun 130033，China
Corresponding author：SUN Hui，E-mail：sunhui1229@163.com
Abstract    The incidence of Hashimoto thyroiditis (HT) combined with thyroid carcinoma，which mostly consists of papillary microcarcinoma (PTMC)，is increasing yearly. Recent research has shown that the immune response of HT in the inflammatory microenvironment can be an inducement of microcarcinoma and an inhibitory factor in its progression. Therefore，when HT combined with PTMC，most scholars advocate pursuing surgical treatment. However，the opportunity and extent of surgery remains controversial. In general，the surgical strategy should be based on the current guidelines and the principle of individualization. For the unilateral and unifocal PTMC in the absence of any risk factors，lobectomy with isthmusectomy is sufficient treatment. For the patient with long course of HT，significantly increased thyroid autoantibodies and TSH levels，confirmed bilateral and multifocal PTMC，or accompanied with cervical lymph node or distant metastases，total thyroidectomy is the recommended. At the same time，ispilateral central neck dissection is necessary，while the lateral neck compartmental lymph node dissection should be performed for patients with clinical evidence-proven metastatic lateral cervical lymphadenopathy. Furthermore，long-term course of HT causes thyroid gland enlargement，angiopsathyrosis and central lymph node hyperplasia, which may raise the difficulty in surgery procedures and injury risk of recurrent laryngeal nerve and parathyroid gland. Therefore，it should be emphasized that the comprehensive application of modern surgical techniques to improve the safety of operation.

Key words: Hashimoto thyroiditis, thyroid microcarcinoma, surgical treatment

摘要：

桥本甲状腺炎（HT）合并甲状腺癌的发病率逐年增高，尤其以合并乳头状微小癌（PTMC）最多见。HT的炎性微环境中的免疫反应既可为PTMC的诱因，又可对PTMC的进展起抑制作用，故HT合并PTMC时仍主张外科处理，但其手术时机和手术范围尚存争议。HT合并PTMC时手术应在遵循指南的基础上，强调个体化诊疗。一般对于单侧叶单发PTMC且无高危因素者，主张行患侧腺叶+峡部切除术；对于HT病史长、甲状腺自身抗体和促甲状腺激素（TSH）水平明显升高、证实双侧多灶癌、伴有颈淋巴结转移或已有远处转移者，则须行全甲状腺切除术。在行腺叶切除同时，应行同侧中央区淋巴结清扫；对于颈侧区肿大淋巴结，原则上在获取证据后再行清扫。由于合并HT时甲状腺腺体增大、易出血、中央区淋巴结增生，使手术难度增高，喉返神经及甲状旁腺损伤风险增加，故强调综合应用现代外科技术以提高手术安全性。

关键词: 桥本甲状腺炎, 甲状腺微小癌, 外科治疗