甲状腺濾胞性腫瘍の手術適応の検討

Surgical indications of thyroid follicular tumors

I．はじめに

　甲状腺の悪性腫瘍である濾胞癌と良性腫瘍である濾胞腺腫との手術前の鑑別は，細胞異型や組織構築の異型ではなく，被膜浸潤や脈管浸潤の有無，甲状腺外への転移に有無により決定される。そのため，臨床所見や超音波検査，穿刺吸引細胞診などで微小浸潤型濾胞癌の術前診断をつけることは非常に困難な場合がある。このような場合，診断を含めた手術を患者に勧めることが多く，諸施設間で術式，追加治療が異なるのが実情である。

　そこで，腫瘍最大径と術前サイログロブリン値に関して濾胞癌と濾胞腺腫の間で比較し，手術適応の補助になるかどうかを検討した。

It is accepted that there is difficult in making a preoperative differential diagnosis between thyroid follicular carcinoma and adenoma. In order to help make decision for operation,maximum diameter and preoperative level of thyroglobulin were compared between follicular carcinoma and adenoma. Subjects were fifteen follicular carcinoma and thirty follicular adenoma of 325 tumors operated on at our Department from 1983 to 2002. Seven cases were all had follicular carcinoma with size of more than 4cm in diameter and with preoperative thyroglobulin level was more than 100ng/ml. It is suggested that surgery is recommended in cases associated with these conditions.