摘要
目的总结结节性甲状腺肿并存甲状腺癌的临床特点及其诊断和治疗要点。方法回顾性分析中国医科大学附属第一医院1998年1月至2007年12月手术治疗并经病理证实的262例结节性甲状腺肿并存甲状腺癌病人的临床资料。结果该组262例,占同期手术治疗甲状腺癌病人的33.9%。发病年龄以40～59岁多见,男:女为1∶5.2。临床表现以结节性甲状腺肿的临床表现为主。除近期行补充根治手术25例术前已明确诊断外,术前超声检查怀疑恶性病变者占70.0%,其中砂砾钙化39.2%。术中冰冻切片快速病理检查诊断准确率为93.2%,16例假阴性,无假阳性病例。肿块直径<2.0cm者占62.9%,其中微小癌40.1%,临床I期病例74%。病理类型以乳头状癌为主(93.1%)。手术方式包括患侧腺叶加峡部切除或加对侧腺叶次全切除术和全甲状腺切除术,对怀疑有颈部淋巴结转移者行颈淋巴结清扫术122例,46例有淋巴结转移。结论结节性甲状腺肿并存甲状腺癌的癌灶较小且淋巴结转移发生率低,乳头状癌占绝对优势;术前超声和术中冰冻切片快速病理检查是提高并存甲状腺癌检出率的关键;对结节性甲状腺肿病人定期随访有利于提高并存甲状腺癌的早期诊断率。
Objective To summarize the clinical characteristics and the highlight of diagnosis and treatment of nodular goiter in patients with coexistent thyroid carcinoma.Methods A total of 262 nodular goiter coexisting with thyroid carcinoma patients underwent operations from January 1998 to December 2007 at the First Hospital, China Medical University were retrospectively reviewed.Results Two hundreds and sixty-two patients accounted for 33.9% in thyroid carcinoma patients at the same time. The age mainly ranged from 40 to 59 years. The sex ratio was 1：5.2 （male：female）. The clinical characteristics were manifested as nodular goiter. In addition to 25 patients who received secondary operation had a clear diagnosis before surgery. 70.0% of tumors were suspected as malignant lesions by preoperative ultrasound examination, in which 39.2% exhibited as microcalcification. The accuracy rate of intra-operative fast frozen section pathological examination was 93.2%. Tumor nodules less than 2.0 cm in diameter accounted for 62.9%, and microcarcinomas accounted for 40.1%. Clinical phase I cases accounted for 74%. The main pathological type was papillary carcinoma（93.1%）. The various styles of thyroidectomy were performed according to the different pathological results. Neck dissection was performed in 122 patients, and 46 of them had cervical lymph node metastasis. Conclusion Most patients with coexisting thyroid carcinomas and nodular goiter have small tumor size and lower incidence of lymph node metastasis. The coexistent thyroid carcinoma was often well differentiated papillary cancer.The preoperative ultrasonography and the intra-operative fast frozen section examination are helpful for the diagnosis of thyroid carcinoma in nodular goiter. Regular follow-up in patients with nodular goiter could improve the early diagnostic rate of coexisting thyroid carcinoma.
出处
《中国实用外科杂志》
CSCD
北大核心
2010年第10期871-873,共3页
Chinese Journal of Practical Surgery
