毒性弥漫性甲状腺肿术后320例临床研究.docVIP

毒性弥漫性甲状腺肿术后320例临床研究摘 要 目的：探讨毒性弥漫性甲状腺肿（Graves病）并发其他甲状腺病的可能性，进一步提高甲状腺疾病的诊治方法。方法：对1995～2002年手术切除的320例Graves病病例的临床资料及诊治经验进行回顾性分析。结果：320例病人术前被单纯地诊断为Graves病267例，Graves病伴结节者53例，术后病理检查发现合并甲状腺癌者9例（约3%），合并腺瘤者86例（约26%），小结节性甲状腺肿136例（43%）。除外9例甲状腺癌，术后1年、3年和5年甲亢、亚甲亢复发者分别是15/300，17/280，13/240；甲减、亚甲减复发者分别是34/300，40/280，64/260，9例甲状腺癌无肿瘤复发。结论：手术治疗的Graves病（甲状腺2度以上）中，约有1/3的病人合并甲状腺肿瘤和小结节增生，以腺瘤为主。Graves病患者术前组织病理学检查是非常必要的。术后甲亢主要发生于1年后，但1年后甲亢复发率无显著差异，而术后1～5年甲减复发率逐年增加，术后1年与5年间甲减复发率有显著差异（P＜0.01）。 关键词 Graves病 甲状腺结节 甲状腺肿瘤 外科手术 AbstractObjective：probe into probability of Graves D combining other thyroid disease and to improve the method of diagnosis and treatment for thyroid disease.Methods：Between 1995 and 2005，320 patients of Graves D were admitted，who were treated by surgical operation.Their clinical data and method were reviewed. Results：267 cases were diagnosed simplified as graves disease in out-patient department.53 cases were diagnosed graves disease combine with thyroid gland nodule.In fact,there were 9 case（3%）were combined with thyroid carcinoma.86(26%) cases combined with thyroid adenoma.136(43%) cases was little nodule of thyroid goitre.Except the 9 thyroid cancers, all the cases were diagnosed again after 1,3 and 3 years.The rate of hyperthyroidism(include sub-hyperthyroidism) were 15/300,17/280，13/240.Hypothyroidism and sub-hypothyroidism occurred rate were 34/300，40/280，64/260.There no case recurred thyroid carcinoma in 9 thyroid carcinoma cases.Conclusion：In patients treated by operation of Graves D whose thyroid gland was 2° tumescence，one of the third combined with thyroid gland nodule and thyroid neoplasms,and mainly was goitre and adenoma.Before surgical, pathology analyzing was need for patient of Graves D.Hyperthyroidism occurred mainly one year after operation.But the rate of hyperthyroidism has no difference after one year.The rat of Hypothyroidism was rise in 1to 5 years.The rate of Hypothyroidism between one and 5 year was different greatly.Thyroid function shoul