本研究旨在探讨单侧多发性乳头状甲状腺微小癌(UMPTMC)应用甲状腺全切术治疗的优势。

回顾性分析2014年9月至2016年9月首次手术治疗的UMPTMC患者90例，其中53例行单侧叶甲状腺切除术(HT)，另外37例行全甲状腺切除术(TT)。采用Pearson卡方检验或Student’s t检验以及Kaplan－Meier方法绘制生存曲线并通过对数秩检验进行统计分析，随后单因素分析采用Cox比例风险法进行无病生存分析，P<0.05被认为有统计学意义。

HT组的所有肿瘤的总直径> 10 mm比TT组中更为常见(39.6%比18.9%; P＝0.046)；TT组患者中央淋巴结转移的阳性率高于HT组(81.1%比60.4%; P＝0.046)；HT组中肿瘤复发的发生率高于TT病例(26.4%比2.7%; P＝0.007); HT组6个月和11个月的无病生存率分别为90.6%(48/53)和73.6%(39/53)，TT组分别为100%(37/37)和91.9%(34/37)，HT患者的无病生存期显著短于TT患者(log－rank检验P＝0.0059)。Cox’s比例风险法的单因素分析显示，男性、所有肿瘤的总直径> 10 mm和中央淋巴结转移是HT患者复发的危险因素。

单侧多发性UMPTMC患者采用甲状腺全切除术可有效降低肿瘤复发率，有利于延长无病生存期，因此随着复发风险的增加，UMPTMC的初次手术更宜选用TT，特别是男性和总肿瘤直径大于10 mm的患者。

The purpose of this study was to investigate the advantages of total thyroidectomy in the treatment of unilateral multiple papillary thyroid microcarcinoma (UMPTMC).

Retrospective analysis of 90 patients with UMPTMC who underwent first operation from September 2014 to September 2016. Of these, 53 underwent unilateral lobar thyroidectomy (HT). The other 37 cases underwent total thyroidectomy (TT). Pearson chi-square test, Student’s t test and Kaplan-Meier method were used to plot the survival curve, and logarithmic rank test was used to score the survival curve. Subsequently, Cox proportional hazard analysis was used to analyze disease-free survival (P<0.05).

The total diameter of all tumors in the HT group was >10 mm more common than in the TT group (39.6% vs.18.9%; P=0.046); the positive rate of central lymph node metastasis was higher in the TT group than in the HT group (81.1% vs. 60.4%) ; P=0.046); the incidence of tumor recurrence in the HT group was higher than in the TT case (26.4% vs. 2.7%; P=0.007). Disease-free survival rates were 90.6% (48/53) and 73.6% (39/53) in the HT group at 6 months and 11 months, and 100% (37/37) and 91.9% (34/37) in the TT group, respectively. Disease-free survival was significantly shorter in the HT group than in the TT group (log-rank test P=0.0059). Univariate analysis of Cox’s proportional hazard analysis showed that men, all tumors with a total diameter > 10 mm and central lymph node metastasis were risk factors for recurrence in HT patients.

Total thyroidectomy for unilateral multiple UMPTMC patients can effectively reduce the recurrence rate of tumor and prolongs the disease-free survival period. Therefore, with the increase of recurrence risk, TT is more appropriate for the initial operation of UMPTMC, especially for male patients and patients with total tumor diameter greater than 10 mm.