Noguchi S, Yamashita H, Murakami N, Nakayama I, Toda M, Kawamoto H
Noguchi Thyroid Clinic and Hospital Foundation, Oita, Japan.
Arch Surg. 1996 Feb;131(2):187-91. doi: 10.1001/archsurg.1996.01430140077021.
To determine the adequate extent of surgery for small carcinomas of the thyroid.
Retrospective cohort study of 867 consecutive patients with small carcinomas of the thyroid (lesions < 10 mm in diameter) who were operated on at the Noguchi Thyroid Clinic, Oita, Japan, between 1965 and 1987. Mean follow-up was 12.8 years.
A center for treatment of thyroid disease, where about 1400 thyroid operations are performed per year.
Thyroidectomy was performed in patients with a preoperative diagnosis of Graves' disease, Graves' disease with nodules, solitary thyroid nodules, multinodular goiters, cysts, chronic thyroiditis and small carcinomas of the thyroid, in 394, 22, 136, 193, 18, 28, and 76 patients, respectively.
Operations were conservative. Three patients who had adenomatous nodular goiters underwent total thyroidectomy. Modified radical neck dissection was performed in 66 patients. Of these 66 patients, 30 had grossly noticeable nodal metastases and 17 had microscopic metastases. Another 50 patients underwent selective lymph node excision, and 28 patients had nodal metastases. Recurrence from remnants of thyroid was seen in five patients. They were treated by surgery. Recurrence in lymph nodes was observed in five patients, and four of them were successfully treated. Recurrence in bone was observed in two patients; one with recurrence in the femur was successfully treated. Two patients died with recurrent cancer.
Small carcinomas of the thyroid can be fatal. Total thyroidectomy is unnecessary. Modified radical neck dissection is unnecessary unless gross nodal metastases are present. Long-term follow-up is mandatory. A
确定甲状腺小癌的适当手术范围。
对1965年至1987年间在日本大分县野口甲状腺诊所接受手术的867例连续甲状腺小癌患者（直径<10mm的病变）进行回顾性队列研究。平均随访时间为12.8年。
一家甲状腺疾病治疗中心，每年约进行1400例甲状腺手术。
分别对术前诊断为格雷夫斯病、伴有结节的格雷夫斯病、孤立性甲状腺结节、多结节性甲状腺肿、囊肿、慢性甲状腺炎和甲状腺小癌的患者进行甲状腺切除术，患者人数分别为394例、22例、136例、193例、18例、28例和76例。
手术较为保守。3例患有腺瘤性结节性甲状腺肿的患者接受了全甲状腺切除术。66例患者进行了改良根治性颈清扫术。在这66例患者中，30例有明显的淋巴结转移，17例有微小转移。另外50例患者接受了选择性淋巴结切除术，28例有淋巴结转移。5例患者出现甲状腺残留复发，均接受了手术治疗。5例患者出现淋巴结复发，其中4例成功治愈。2例患者出现骨转移，1例股骨转移患者成功治愈。2例患者死于癌症复发。
甲状腺小癌可能致命。全甲状腺切除术并非必要。除非存在明显的淋巴结转移，否则改良根治性颈清扫术也不必要。必须进行长期随访。
