桥本氏病临床诊断及治疗研究.docVIP

桥本氏病临床诊断及治疗研究【摘要】目的研究桥本氏病的的诊断和手术治疗方法。方法回顾性总结46例桥本氏病的临床资料和手术体会。结果46例患者均确诊为桥本氏病；其中以第一诊断为桥本氏病入院者30例，经服激素和甲状腺片治疗多数有效。共手术治疗28例，行双侧次全切10例，单侧全切12例，单侧部分切除活检4例，峡部切除2例。28例患者术后均痊愈出院。术后远期出现甲低者4例，无其他并发症发生。结论桥本氏病诊断有赖于TGA、TGM、B超、穿刺细胞学或手术病理学检查。以保守治疗为主，采用手术要慎重。 【关键词】桥本氏病;诊断;手术治疗 Hashimotos disease clinical diagnosis and treatment analysisLI Tao In general surgery department two of Shangqiu First Peoples Hospital of Henan province,Shanqiu 476100,China 【Abstract】ObjectiveTo study Hashimoto s disease diagnosis and operation treatment method MethodsA retrospective review of 46 cases of Hashimotos disease clinical data and operation experience ResultsThe results of the 46patients were diagnosed with Hashimotos disease; the first diagnosis of Hashimotos disease was admitted in 30 cases, served by the hormone and thyroid tablets in the treatment of most effective Co operation in treatment of 28 cases, bilateral subtotal resection in 10 cases Total resection in 12 cases, unilateral partial excision biopsy in 4 cases, resection in 2 cases 28 patients were cured and discharged Long term postoperative emergence of hypothyroidism in 4 cases, no other complications occurred ConclusionThe diagnosis of Hashimotos disease depends on the TGA, TGM, B ultrasound, aspiration cytologic or histopathologic examination of operation Mainly to conservative treatment, the operation should be cautious. 【Key words】Hashimotos disease;Diagnosis;Operation treatment 作者单位：476100河南省商丘市第一人民医院普外二科桥本氏病(HashimotoS disease)，是一种自身免疫性疾病，称桥本氏甲状腺炎或慢性淋巴细胞性甲状腺炎，临床上比较常见。由于该病缺乏特异性的临床表现及检测指标，桥本氏病无特征性，并且常常合并各种甲状腺疾病，临床表现复杂，误诊漏诊率较高［1］。所以临床上极易误诊或漏诊。本文回顾性总结46例桥本氏病的诊断治疗情况和手术体会。现分析讨论如下。 1临床资料 11一般资料本组患者46例，年龄24～72岁，平均374岁；其中女40例，男6例，病程25 d～52年，平均164个月；患者体格检查均无突眼，全部患者均为颈部增粗首发症状诊治，并发单个结节11例，结节性肿大28例，直径06～44 cm；均未触及颈部淋巴结肿大；患者甲状腺球蛋白抗体(TGA)、甲状腺微粒体抗体(TMCA)升高31例；患者测定血清T3、T4、TSH，其中T4增高7例，T3、TSH均正常；术前细针穿刺细胞学检查(FNAB)14例，HD9例，可疑癌8例；甲状腺弥漫性肿大I～Ⅱ°38例、Ⅲ°8例；术前诊断：HD10例、HD合并TC 5例、TC 5例、甲状腺腺瘤18例，结节性甲状腺肿8例。 12治疗本组46例