| [Objective] PTMC defined as papillary thyroid cancer no larger than 1.0 cm (≤1 cm), with or without lymph metastasis. PTMC has small lesions, mostly located in the gland, lack of obvious clinical signs and symptoms, so the general clinical examination often can not find it easily. It was observed that the majority of PTMC has a "benign" biological characteristics, therefore, scholars have disagreed its surgical method. This article focuses on to investigate the surgical diagnosis and treatment of PTMC.[Methods] All patients from January 2009 to January 2 010 in our hospital were collected, 363 cases of surgical treatment of PTMC were analyzed retrospectively. All patients underwent preoperative ultrasonography examination, 348 cases were highly suspected malignant. All patients had no distant metastasis before surgery.30 cases were dignosised by ultrasound-guided coarse needle biopsy (CNB). All patients underwent intraoperative frozen biopsy, 331 cases was diagnosed by intraoperative frozen pathology, another 32 cases were diagnosed by paraffin pathological; 108 cases were multifocal cancer, accounted for 29.75% of patients with PTMC. Others were unifocal cancer. In 363 cases, 236 cases combined of nodular goiter; 45 cases combined of thyroiditis; concomitant nodular goiter and thyroiditis in 66 cases; Among them,there were 180 cases receiving total thyroidectomy of the affected lobe plus subtotal thyroidectomy of the opposite lobe;20cases receiving total thyroidectomy of the affected lobe plus neartotal thyroidectomy of the opposite lobe;3cases receiving total thyroidectomy of the affected lobe plus partial thyroidectomy of the opposite lobe;6 cases receiving bilateral subtotal thyroidectomy;68 cases receiving bilateral total thyroidectomy;14 cases receiving unilateral total thyroidectomy; 50 cases receiving total thyroidectomy of the affected lobe plus thyroidectomy of isthmus; 9 cases receiving isthmus cancer resection plus neartotal thyroidectomy or subtotal thyroidectomy of the two lobe. 241 cases receiving modified radical neck dissection, in which 157 cases only received VI district modified radical neck dissection, 51 cases had lymph node metastasis; 34 cases only received lateral cervical lymph node dissection, 9 cases had lymph node metastasis; 50 cases received VI district and lateral cervical lymph nodes dissection, in which 13 patients showed all had metastasis, 5 cases only VI district had metastasis, and 3 cases only occurred lateral cervical metastasis. 83 multifocal cancer patients with routine cervical cancer lymph node dissection, in which 48cases only received VI district modified radical neck dissection, 20 cases had lymph node metastasis; 16cases only received lateral cervical lymph node dissection,4 cases had lymph node metastasis; 19 cases received VI district and lateral cervical lymph nodes dissection, in which 3 patients showed all had metastasis, 2 cases only VI district had metastasis , and 1 cases only occurred lateral cervical metastasis.[Result] All the patients had no permanent hypoparathyroidism and Permanent vocal cord paralysis.Some patients with adjuvant radioactive iodine treatment. All patients with oral thyroxine tablets (euthyrox) inhibition of replacement therapy. All patients were followed up, and during this time no tumor recurrence and distant metastasis, no death. For all cases, 348 cases were diagnosed by ultrasonography suspected cancer, ultrasound diagnosis was 95.87%. Other cases in this group, 17 cases of intraoperative frozen pathology return except for the suspicious cancer or cancer, but postoperative pathological paraffin were PTMC, including 15 patients with a preoperative ultrasound imaging as hypoechoic nodules prompted the border is not clear, a high degree of suspicion malignant nodules. CNB can take larger tissue than FNB removed, which can meet the needs of histopathological diagnosis. 30 patients had this examination, the diagnosis of thyroid cancer was 100%, and no patient developed complications. In all the multifocal cancer cases, 75 cases were bilateral lobe cancer, accounting for 20.66% of patients with small carcinoma (75/363), of which 11 cases only had unilateral ultrasound leaf nodules.Echocardiographic characteristics of these 11 patients were node close to the isthmus. In all cases, 207cases received VI district modified radical neck dissection, 69 patients had metastasis, lymph node metastasis was 33.33% (69/207), multifocal PTMC lymph node metastasis was 37.31% (25/67); 84 patients received lateral neck Department of lymph node dissection, 25 patients had lymph node metastasis, lymph node metastasis was 29.76% (25/84), the transfer region mainly in II ~ IV area.[Conclution] Ultrasound is a sensitive and inexpensive method to check the thyroid and cervical lymph nodes, if the surgeon to do ultrasound for patients, taking into account the clinical experience can improve the detection rate of PTMC. Ultrasound-guided needle biopsy can provide sufficient tissue for pathological diagnosis, so we suggestde ultrasound-guided coarse needle biopsy as a routine preoperative diagnosis examination of thyroid nodules; For surgical resection, in general, it's difficult to judge the bilateral foci is a multi-glandular leaf central or metastatic. But no matter what type of them relatively poor biological behavior, therefore, need to whole bilateral lobe resection. For unilateral lesions and unilateral multi-leaf single leaf which near the isthmus lesion, we suggested PTMC unilateral leaf total resection, and at the same time subtotal resection of contralateral lobe. For the isthmus PTMC, isthmus resection and subtotal resection or near total resection of double-leaf is enough. All PTMC patients should routinely have district VI lymph node dissection ,because in all differentiated thyroid cancer, district VI has a higher lymph node metastasis, some studies reported that district VI occult lymph nodes metastasis rate was from 50% to 60%. Pattern of lymph node metastasis of thyroid cancer is usually considered the primary tumor-VI lymph nodes - side of the neck lymph nodes - distal metastasis, so VI lymph nodes removed in conjunction with the primary tumor may block the transfer of its sideways to neck area, reducing after cervical lymph node metastasis and improve prognosis. At the first operation, the anatomic level is clear, can let very few serious complications. For the lateral neck area, if such as the lymph nodes has no doubt before surgery, you do not need prophylactic lateral neck dissection.
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