桥本甲状腺炎伴结节外科诊治研究.docVIP

桥本甲状腺炎伴结节外科诊治研究【摘要】　目的：总结桥本甲状腺炎伴结节的外科诊治体会。方法：分析笔者所在医院于2006-2011年间收治的经手术病理证实的桥本甲状腺炎52例临床资料，探讨桥本甲状腺炎伴结节的外科诊治进展。结果：所有患者进行3个月~5年的随访，无复发。全组无喉返神经损伤，有2例(3.8%)甲状旁腺功能低下。结论：桥本甲状腺炎与甲状腺癌有着密切关系。对怀疑有恶变的甲状腺结节，行细针穿刺细胞学检查或手术探查是提高甲状腺癌检出率的关键。 【关键词】　桥本甲状腺炎；　甲状腺癌；　甲状腺切除术 Study of the Diagnosis and Treatment of Thyroid Nodules Associated with Hashimoto’s Thyroiditis/XU Xiao-hong，TANG Zhi-qin.//Medical Innovation of China，2012，9(28):119-120 【Abstract】　Objective:The purpose of this article is to compare the features of benign and malignant nodules in patients with diffuse Hashimotos thyroiditis.Method:Clinical data and approaches to diagnosis and treatment of patients with diffuse Hashimoto?s thyroiditis were retrospectively analyzed.Result:All the patients were followed up in the range of three months to five years.There was no recurrence and no injury of N.laryngeus recurrens.There were 2 cases(3.8%) with hypoparathyroidism.Conclusion:There is a relation between Hashimoto?s thyroiditis and thyroid carcinoma.Patients with diffuse Hashimoto’s thyroiditis and coexisting nodules could be confirmed to be benign or malignant by fine-needle aspiration or surgical pathologic analysis. 【Key words】　Hashimotos thyroiditis;　Thyroid carcinoma;　Thyroidectory First-authors address:Affiliated Jiading Branch of Medicine College of Shanghai Jiaotong University　Jiading District Central Hospital，Shanghai 201800，China doi：10.3969/j.issn.1674-4985.2012.28.075 桥本甲状腺炎(Hashimotos thyroiditis，HT)又名慢性淋巴细胞性甲状腺炎，是一种较为常见的自身免疫性疾病，患者常表现为双侧甲状腺弥漫性肿大，可伴局部肿块或结节形成。桥本甲状腺炎有可能并发甲状腺恶性肿瘤[1]。文献报道国内外差异较大，国外为0.5%~22.3%[2-4]，国内为0.6%~23.8%[5-6]。笔者所在医院于2006-2011年共收治手术病理证实的桥本甲状腺炎52例，其中并发甲状腺癌6例，甲状腺恶性淋巴瘤1例，现报告如下。 1　资料与方法 1.1　一般资料　本组52例，其中良性病变45例，恶性病变7例。良性病变组年龄27~82岁，平均年龄(50.64±12.39)岁；女43例，男2例，均以甲状腺肿块就诊，主要通过体检和B超发现。其中单发肿块22例，多发肿块23例。肿块大小0.7~4.0 cm，平均直径(1.54±0.62)cm，伴颈部疼痛3例，压迫感8例，吞咽异物感2例，合并甲状腺功能亢进5例，合并甲状腺肿大2度5例，甲状腺肿大3度4例，B超提示结节伴粗大钙化5例。血清学检查：T3、T4值高于正常5例，TSH增高9例，抗甲状腺球蛋白抗体(TGAb)升高者28例，抗甲状腺过氧化物酶抗体(TPOAb)升高者23例，二者同时升高者22例，二者