目的:通过比较峡部甲状腺微小乳头状癌(papillary thyroid microcarcinoma of the isthmus,PTM-CI)患者经不同手术方式治疗的预后,探讨PTMCI最合适的手术方案,为临床手术方式选择提供参考.方法:回顾性分析2016年1月-2023年6月在宁波市医疗中心李惠利医院耳鼻咽喉头颈外科手术治疗且术后病理确诊为PTMCI患者(106例)的临床资料.根据甲状腺侧叶是否伴有结节将患者分为3组,分别为孤立性PTMCI组、PTMCI伴单侧叶结节组、PTMCI伴双侧叶结节组.结合随访信息,比较各组经不同手术方式治疗后复发率、生存率、术后并发症等差异,其中术式包括甲状腺峡部切除术、甲状腺峡部+单侧叶切除术和甲状腺全切除术,所有患者均同期行中央区淋巴结清扫术.结果:各组经不同手术方式治疗后复发率、生存率、术后并发症比较,差异无统计学意义.2例患者术后出现复发,其中1例为PTMCI伴单侧叶多灶癌行峡部+单侧叶切除+同侧中央区淋巴结清扫术,复发表现为对侧侧颈淋巴结转移;另1例为PTMCI伴双侧叶良性结节行峡部+单侧叶切除+同侧中央区淋巴结清扫术,复发表现为残余腺体复发.1例患者术后出现永久性声嘶.31例(29.2％)患者术后病理提示甲状腺内存在多灶癌,41例(38.7％)患者术后病理提示存在颈部中央区淋巴结转移.患者疾病特异性生存率为100％.结论:孤立性PTMCI建议行甲状腺峡部切除术;PTMCI伴单侧叶结节可行甲状腺峡部+单侧叶切除术,若单侧叶内多发可疑恶性结节灶(≥3个)建议行甲状腺全切除术;PTMCI伴双侧叶结节可行甲状腺全切除术.所有PTMCI患者均应同期行预防性颈部中央区淋巴结清扫术.
Surgical approach selection and prognosis analysis of papillary thyroid microcarcinoma in the isthmus
Objective:To compare the prognosis of papillary thyroid microcarcinoma of the isthmus(PTMCI)after different surgical methods,and to investigate the most appropriate surgical plan for it,so as to provide refer-ence for the selection of clinical surgical plan.Methods:The clinical data of 106 PTMCI patients diagnosed with postoperative pathology after surgical treatment in Department of Otolaryngology Head and Neck Surgery,Ning-bo Medical Center Lihuili Hospital from January 2016 to June 2023 were retrospectively analyzed.The patients were divided into 3 groups according to whether there were nodules in the lateral lobe of the thyroid gland,name-ly,isolated PTMCI group,PTMCI group with unilateral lobe nodules,and PTMCI group with bilateral lobe nod-ules.Combined with follow-up information,the differences of recurrence rate,survival rate and postoperative complications after different surgical methods were compared among all groups.The surgical procedures included isthmic thyroidectomy,isthmic+unilateral lobectomy,and total thyroidectomy.All patients underwent central lymph node dissection at the same time.Results:There were no significant difference in recurrence rate,survival rate and postoperative complications among all groups and between groups.Postoperative recurrence occurred in 2 patients,among which 1 patient was PTMCI with multiple focal tumors in unilateral lobe undergoing isthmus+unilateral lobectomy+ipsilateral central lymph node dissection.The recurrence was manifested as contralateral cervical lymph node metastasis.Another case of PTMCI with bilateral benign nodules underwent isthmus+uni-lateral lobe(larger nodule)resection+ipsilateral central lymph node dissection,and the recurrence was manifes-ted as residual glandular recurrence.One patient developed permanent hoarseness after surgery.The postoperative pathology of 31 patients(29.2％)indicated multiple focal thyroid carcinoma.Postoperative pathology of 41 pa-tients(38.7％)suggested lymph node metastasis in the central region of neck.The disease-specific survival rate was 100％.Conclusion:Isthmic thyroidectomy is recommended for isolated PTMCI.Isthmus of thyroid+unilat-eral lobectomy is feasible for PTMCI with unilateral lobectomy.If multiple suspicious malignant nodules(≥3)oc-cur in unilateral lobectomy,total thyroidectomy is recommended.Total thyroidectomy is feasible for PTMCI with bilateral nodules.All PTMCI patients should undergo prophylactic central cervical lymph node dissection at the same time.
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