Wu Arthur W, Wang Marilene B, Nguyen Chau T
Division of Head and Neck Surgery, Department of Surgery, University of California, Los Angeles, USA.
Arch Otolaryngol Head Neck Surg. 2010 Dec;136(12):1182-90. doi: 10.1001/archoto.2010.193.
recently, there has been a debate regarding total thyroidectomy vs hemithyroidectomy for papillary thyroid microcarcinoma (PTMC).
to determine whether there were significant differences in the treatment of PTMC depending on a physician's experience, age, training, and location.
a 10-question survey was distributed to otolaryngologists, general surgeons, and endocrine surgeons. It included 4 clinical scenarios, 2 questions querying clinical reasoning, and 4 demographic questions (training, surgical volume, location, and age). The demographic variables were used to analyze responses to the 4 clinical scenarios with bivariate and multivariate statistics.
a total of 438 responders completed the survey. Given a single subcentimeter PTMC, 70.3% of surgeons recommended no further surgery after a hemithyroidectomy, yet 29.7% believed that completion thyroidectomy was necessary. Otolaryngologists chose total thyroidectomy more frequently, as did surgeons from the South and West. Given PTMC with lymphatic invasion, 392 (89.5%) responders recommended completion thyroidectomy, with otolaryngologists again more inclined toward completion surgery. Given multifocal PTMC, 85.4% chose completion thyroidectomy, with surgeons in the South and West recommending total thyroidectomy more frequently compared with those in the Northeast. Improved survival, surgeon preference, and need for thyroid suppression were rated relatively insignificant. Ease of patient follow-up and multifocality of disease were judged very significant. Influence from national guidelines and current literature was rated as only somewhat or minimally significant.
in this survey, most surgeons seemed to follow national guidelines regarding the surgical treatment of PTMC. However, significant differences in the treatment and perception of PTMC exist based on surgical training and location.
最近，关于甲状腺微小乳头状癌（PTMC）行全甲状腺切除术与半甲状腺切除术存在争议。
确定PTMC的治疗在医生经验、年龄、培训及所在地区方面是否存在显著差异。
向耳鼻喉科医生、普通外科医生及内分泌外科医生发放一份包含10个问题的调查问卷。其中包括4个临床病例、2个询问临床推理的问题以及4个人口统计学问题（培训、手术量、所在地区及年龄）。利用人口统计学变量通过双变量和多变量统计分析对4个临床病例的回答。
共有438名受访者完成了调查。对于单个直径小于1厘米的PTMC，70.3%的外科医生建议在半甲状腺切除术后无需进一步手术，但29.7%的医生认为需要行甲状腺全切术。耳鼻喉科医生更常选择全甲状腺切除术，来自南部和西部的外科医生也是如此。对于伴有淋巴结侵犯的PTMC，392名（89.5%）受访者建议行甲状腺全切术，耳鼻喉科医生再次更倾向于全切手术。对于多灶性PTMC，85.4%的医生选择全切术，与东北部的医生相比，南部和西部的医生更常建议行全甲状腺切除术。改善生存率、医生偏好及甲状腺抑制需求被认为相对不重要。患者随访的便利性及疾病的多灶性被判定非常重要。国家指南和当前文献的影响被评为仅有些重要或不太重要。
在本次调查中，大多数外科医生似乎遵循关于PTMC外科治疗的国家指南。然而，基于外科培训及所在地区，PTMC的治疗及认知存在显著差异。
