外科诊治甲状腺结核的方法选择(5例报道及文献复习)  

Method Choices in Diagnosis and Treatment of Thyroid Tuberculosis:Report of Five Cases and Review of Literatures

作　　者：蒯勇[1] 郭冬[1] 张永臻[1] 张学功[1] 穆庆岭[2] 

机构地区：[1]山东省日照市人民医院普外二科,山东日照276826 [2]山东省立医院普外科,山东济南250012

出　　处：《中国普外基础与临床杂志》2011年第7期755-758,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨甲状腺结核诊断和治疗的技术选择,以及临床分型和流行病学特点。方法回顾性总结我们收治的5例甲状腺结核的临床资料,并结合相关文献分析甲状腺结核的疾病特点、诊治要点、误诊原因和手术方式。结果 所有患者术前均误诊,术中病理确诊2例,术后病理确诊3例。其中4例为干酪型,1例为增生型,均属慢性甲状腺结核,无急性甲状腺结核病例。手术根据病灶特点切除甲状腺一叶或大部（3例）,不能切除者清除坏死组织后局部置药（2例）。术后行正规抗结核治疗6~8个月。所有患者均治愈。分别获随访2、5、7、8及15年,无复发。结论 甲状腺结核一般术前诊断困难,治疗宜根据甲状腺结核的病理类型、病灶特点和伴发疾病而定,选择手术切除、清创置药、局部注药或全身抗结核治疗。增生型可手术切除,干酪型若切除困难,可选择清除病灶,局部置药。Objective To investigate the diagnosis,treatment,classification,and epidemiology of thyroid tuberculosis.Methods A retrospective study of 5 cases of thyroid tuberculosis and a review of the literatures were analyzed,which related to the clinical characteristics,the gist of the diagnosis and treatment,the causes of misdiagnosis and the methods of operation.Results All of the cases were misdiagnosed before operation.Two cases were diagnosed by the frozen sections during the operations and three cases were diagnosed by postoperative pathology.Subtotal resection or lobectomy and local excision（3 cases） were performed respectively.Debidement and anti-tuberculosis medicine were given locally in 2 unresectable cases.All patients underwent standard chemotherapy for 6-8 months after operations and recovered finally.Four cases were caseous necrosis,1 case was hyperplasia,all of which were chronic infections thyroid tuberculosis,and no acute thyroid tuberculosis be found.No recurrence was found in the 2-15 years of follow-up.Conclusions Usually,it is difficult to establish a definite preoperative diagnosis for thyroid tuberculosis.Treatment,such as resection,debridement with local medication or systemic chemotherapy,shall be taken individually according to pathology types,focal features,and comorbidities.For hyperplasia cases,surgical resection shall be the best choice,while,for caseous necrosis cases,sometime difficult to remove,debridement with local medication may be suitable.

关 键 词：甲状腺疾病 结核 外科手术 诊断 治疗 

分 类 号：R529.0[医药卫生—内科学]