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目的:探讨多灶甲状腺微小乳头状癌(PTMC)的临床病理特征。方法:回顾性分析2013年5月—2016年4月297例手术治疗并经病理证实的PTMC患者临床资料。结果:297例PTMC患者中,多灶PTMC 70例(23.6%)。与单灶PTMC患者比较,多灶PTMC患者肿瘤直径小(0.54 cm vs.0.69 cm)、包膜侵犯率高(18.6%vs.8.8%)、行甲状腺全切比例高(87.1%vs.41.4%),差异均有统计学意义(均P<0.05)。癌灶数≥3多灶PTMC患者与癌灶数=2的PTMC患者比较,前者合并双侧癌的比例增高(88.2%vs.44.4%)、中央区淋巴结转移的比例增高(47.1%vs.22.2%),差异均有统计学意义(均P<0.05)。结论:多灶PTMC的病灶更为微小且更易出现包膜侵犯;多灶PTMC的病灶数越多合并双侧癌和中央区淋巴结转移的风险就越大;多灶PTMC应常规行预防性中央区淋巴结清扫。
Objective: To investigate the clinicopathological features of multifocal thyroid papillary carcinoma (PTMC). Methods: The clinical data of 297 PTM patients who were surgically treated and pathologically confirmed from May 2013 to April 2016 were retrospectively analyzed. RESULTS: Among 297 PTMC patients, multifocal PTMC was found in 70 patients (23.6%). Compared with single-site PTMC patients, the multi-tumor PTMC patients had small tumor diameter (0.54 cm vs. 0.69 cm), high envelope invasion rate (18.6% vs.8.8%), high total thyroidectomy volume ratio (87.1% vs.41.4% ), The differences were statistically significant (all P <0.05). The proportion of patients with PTMC with multifoci ≥3 multifocal PTMC was significantly higher in patients with PTMC than those with PTOC = 2 (88.2% vs.44.4%, 47.1% vs.22.2 %), The differences were statistically significant (all P <0.05). Conclusions: The lesions of multifocal PTMC are more subtle and more prone to envelope invasion. The more multifocal PTMC lesions are, the higher the risk of bilateral and central lymph node metastases. The multifocal PTMC should be routinely treated with prophylactic central zone Lymph node dissection.