中国实用外科杂志2023年2月第43卷第2期·159·指南（共识）解读D0L:l0.195385.cjps.issnl005-2208.2023.02.08日本《成人低危型甲状腺微小乳头状癌主动监测与管理共识声明(2021版)》解读刘俊松，许崇文，张少强[摘要】日本《成人低危型甲状擦微小乳头状癌主动监测management of adult patients diagnosed with low-risk与管理共识声明(2021版)》由日本内分法外科学会组织甲papillary thyroid microcarcinoma (PTMC).Based on the latest状腺癌领城多学科专家（内分法外科、甲状撩外科、头颈外clinical evidence,the relationship between tumor and tracheal科医师、内分泌科、病理科)，基于最新临床研究证据，对甲and laryngeal recurrent nerve was discussed in detail.Factors,状腺微小乳头状癌主动监测和手术指征进行详细论证和including age,multiplicity,family history,desire to bear阐述，尤其是对肿瘤与气管、喉返种经的关系，年龄、多灶children and pregnancy,calcification,vascularity,the性、家族史、怀孕意愿、结节钙化情况、结节血供、合并桥本coexistence of Graves'disease,and benign nodules were甲状擦炎或甲状腺良性结节等因素对甲状腺微小乳头状discussed when choosing active surveillance for patients with癌主动监测和预后的影响，以及对主动监测的具体随访问PTMC.The consensus statements also gave answers to follow-题作出解答，并对未来研究方向进行展望，为临床实践提up and monitoring questions and gave an outlook for the future供参考。research direction.【关键词】甲状藤微小乳头状癌；主动鉴测；共识声明Keywords papillary thyroid microcarcinoma;active中图分类号：R6文献标志码：Asurveillance;consensus statementsInterpretation of Indications and Strategy for Active Sur-甲状腺癌的发病率在全球范围内迅速增加，且以甲状veillance of Adult Low-Risk Papillary Thyroid Microcar-腺微小乳头状癌(papillary thyroid microcarcinoma,TMC)cinoma (Japan,2021)LIU Jun-song,XU Chong-wen,发病率增加为主，然而甲状腺癌的死亡率并未明显变化，ZHANG Shao-qiang.Department of Otorhinolaryngology-因此引发了临床医生对PTMC过度诊断和过度治疗的思Head and Neck Surgery,the First Affiliated Hospital of Xi'an考-。自20世纪90年代开始，日本Kuma医院和癌症研究Jiaotong University,Xi'an 710061,China所医院开展了对低危型甲状腺微小乳头状癌(w-ikCorrespondingauthor:ZHANG Shao-giang,E-mailentsqzhang@papillary thyroid microcarcinoma.IR-PTMC )(TlaNOMO)163.com行主动监测(active surveillance,AS)的研究，并得出非常积Abstract Indications and Strategy for Active Surveillance of极的研究结果：(1)观察期间肿瘤生长和出现淋巴结转移Adult Low-Risk Papillary Thyroid Microcarcinoma:的概率很低：(2)终止观察而选择手术治疗的病人中，未出Consensus Statements from the Japan Association of现危及生命的复发或死亡病人：(3)AS期间未出现远处转Endocrine Surgery Task Force on Management for Papillary移或死于甲状腺癌病人。随后，AS获得广泛关注，并被Thyroid Microcarcinoma.The association organized experts in列入全世界多个国家和学术团体的甲状腺癌诊疗指南。thyroid carcinoma in endocrine surgery,thyroid surgery,head2021年，日本内分泌外科学会针对成人LR-TMC的and neck surgery,endocrinology,and pathology.The expertsAS与管理制定了专家共识声明.即《成人低危型甲状腺微collected and analyzed bibliographic evidence and produced小乳头状癌主动监测与管理共识声明(2021版)》（以下简the present consensus statements regarding indications and称《共识》)，发表于Tho。该《共识》共提出16条建议，concrete strategies for active surveillance to facilitate the内容涵盖PTMC的AS和立即手术指征、疾病评估方法和内容、影响AS决策的因素、AS随访方法与内容、AS期间是否基金项目：国家自然科学基金青年项目(No82103568):陕西行促甲状腺激素(thyroid stimulating hormone,TSH)抑制管省自然科学基础研究计划(No2021J0-405)理、随访期限，并对未来基因检测以及随访过程中病人可作者单位：西安交通大学第一附属医院耳鼻咽喉头颈外科能存在的焦虑情绪管理作出展望。本文将结合PTMC研究陕西西安710061进展对《共识》内容进行解读。通信作者：张少强，E-ail:entsogzhang(@163com(C)1994-2023 China Academic Journal Electronic Publishing House.All rights reserved.http://www.cnki.net
