Abstract:

Diagnosis and treament of postsurgical incidental papillary thyroid microcarcinoma: A clinical analysis of 34 cases        SHAO Tang-lei*, WANG Zhen-qian, JIANG Xiao, et al. *Department of Thyroid-Vascular Surgery, Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China
Corresponding author:YAN Ji-qi.E-mail:yanjiqi@aliyun.com
Abstract    Objective    To discuss the treatment of postsurgical incidental papillary thyroid microcarcinoma(PIPTMC).Methods    The clinical data of 21 patients with PIPTMC treated in Ruijin Hospital,Shanghai Jiao Tong University School of Medicine and 13 patients with PIPTMC treated in 85 Hospital of People’s Liberation Army between January 2007 and December 2014 were analyzed retrospectively. A total of 34 consecutive PIPTMC patients were divided into Group A and B .There were 9 patients in group A , who underwent subtotal thyroidectomy in unilateral lobe.There were 25 patients in group B who underwent subtotal thyroidectomy in bilateral lobe. Group B was made further division into group B1 and B2.There were 18 patients in group B1 whose one lobe diagnosed with papillary thyroid carcinoma and the opposite side diagnosed with PIPTMC.There were 7 patients in group B2 whose one lobe diagnosed with PIPTMC and the opposite side diagnosed with benign disease. Results    No carcinoma tissue was found in the residual thyroid in group A and B2 and no metastasis found in central lymph nodes. But there were 5 of 12 patients in group B1 whose carcinoma tissue was found in the residual thyroid and metastasis was found in the central lymph nodes. The 5 cases were diagnosed with multifocal cancer in the first operation, and no carcinoma tissue was found in the thyroid of the other 13 cases in group B1 and no metastasis found in central lymph nodes. One case of transient RLNs palsy was found in group A, and 4 in group B,also there were 6 cases of transient hypocalcemia and 3 cases of permanent hypocalcemia found in group B after operation. Conclusion    Most of PIPTMC patients can be followed up and don’t need to be reoperated hastily,but the PIPTMC patient whose unilateral lobe was diagnosed with multifocal cancer and the opposite lobe was diagnosed with PIPTMC in the first operation should be treated actively as soon as possible.

Key words: papillary thyroid microcarcinoma, postsurgical incidental papillary thyroid microcarcinoma

摘要：

目的    对术后意外甲状腺微小乳头状癌（PIPTMC）的诊治进行探讨。方法    回顾性分析2007年1月至2014年12月上海交通大学医学院附属瑞金医院21例和解放军八五医院诊治的13例PIPTMC病人资料。34例病人分组：A组（9例），初次手术仅行单侧甲状腺次全切除术；B组（25例），初次行双侧甲状腺手术。B组又分为：B1组（18例），一侧患甲状腺癌行侧腺叶全切除术+中央区淋巴结清扫术，另一侧行次全切除术后发现PIPTMC；B2组（7例），双侧次全切除术，其中一侧术后证实为PIPTMC。结果    A组和B2组残留甲状腺未见癌组织，中央区淋巴结未见癌转移。B1组12例再次术前B超发现有残留结节者中，5例残留甲状腺发现有微小癌灶，且中央区淋巴结有癌转移，这5例首次病理学检查结果提示非PIPTMC侧为多灶癌；余B1组13例残留甲状腺未发现癌组织，中央区淋巴结未见癌转移。A组术后发生1例（11.1%）暂时性神经麻痹；B组术后发生暂时性神经麻痹4例（16%），暂时性低钙血症6例（24%），永久性低钙血症3例（12%）。结论    PIPTMC者多数情况下可以先观察随访，不必急于再次手术。但对于一侧为甲状腺多灶性乳头状癌，一侧为PIPTMC者，由于存在残留癌灶和中央区淋巴结转移的风险，建议尽早再次彻底手术。

关键词: 甲状腺微小乳头状瘤, 术后意外甲状腺微小乳头状癌