结节性甲状腺肿合并甲状腺癌的临床分析  

Clinical analysis of patients with nodular goiter concomitant thyroid cancer

作　　者：米泰宇[1] 刘开坤[1] 

机构地区：[1]甘肃省兰州市第二人民医院普外三科,甘肃兰州730046

出　　处：《中国普通外科杂志》2011年第9期979-983,共5页China Journal of General Surgery

摘　　要：目的探讨结节性甲状腺肿(结甲)合并甲状腺癌(甲癌)的临床特点和外科诊治方法。方法回顾性分析2008年1月—2011年1月收治的1 859例结甲中142例(7.6%)合并甲癌患者的临床资料。结果 142例均行手术治疗。112例为初次手术,30例为二次(补充)手术。男∶女=1∶3.1,临床表现以结甲表现为主。术前超声检查疑诊合并甲癌55例(38.7%),其中结节砂砾钙化21例。12例伴颈部淋巴结肿大。90例行高分辨率彩色多普勒超声检查,75.6%(68/90)疑有恶性病变。45例行细针穿刺细胞病理学检查(FNA),确诊率48.9%(22/45)。138例术中冷冻切片快速病理诊断准确率96.4%,假阴性5例,无假阳性病例。甲癌83例为单发癌灶,59例为多发癌灶,病灶<2 cm者占75.3%。病理类型以乳头状癌为主(75.4%)。64例伴淋巴结转移。手术方式包括:患侧腺叶+峡部全切除术;患侧腺叶+峡部+对侧腺叶次全切除术或甲状腺全切除术和同侧或双侧中央区(VI区)淋巴结清扫;颈部淋巴结肿大和术中或术前怀疑颈部淋巴结转移者加行改良颈清扫术。142例术后均予以左旋甲状腺素治疗,101例行131I治疗。术后随访6个月至3年,8例患者复发并进行2次手术治疗,1例由于甲状腺癌肺转移死亡。结论结甲合并甲癌以乳头状癌为主,病灶以<2 cm多见。术前超声、FNA和术中冷冻切片快速病理检查可提高结甲合并甲癌的检出率,有效避免漏诊误诊。对结甲患者加大跟踪随访强度可提高合并甲癌的早期检出率。Objective To study the clinical features,diagnosis and treatment of patients with nodular goiter concomitant thyroid cancer.Methods The clinical data of 142 cases with concomitant thyroid cancer in 1 859 cases of nodular goiter admitted from January 2008 to January 2011 were retrospectively analyzed.Results All the 142 patients underwent surgical treatment,of which,there were 112 cases of primary surgery and 30 cases of secondary surgery.The ratio of men to women was 1∶3.1,and the patients predominantly manifested as nodular goiter.Fifty-five cases（38.7%） were suspected of having concomitant thyroid cancer as suggested by preoperative ultrasound examination,of which 21 cases（18.7%） had nodular psammomatous calcification.Twelve cases had cervical lymph node enlargement.Ninety patients underwent high-resolution color Doppler ultrasound examination,of which 68 cases（75.6%） were suspected of having malignant lesion.Fine needle aspirations（FNA） were performed in 45 cases and the correct diagnostic rate was 48.9%.The pathological examinations of intraoperative fast frozen section were performed in 138 patients,with accuracy rate of 96.4%,5 false negative cases and no false positive case.Of the patients with thyroid cancer,83 cases were unifocal and 59 cases were multifocal,lesions less than 2.0 cm accounted for 75.3%,the main pathological type was papillary carcinoma（75.4%）,and 64 cases showed lymph node metastasis.The surgical procedures comprised ipsilateral total lobectomy combined with isthmusectomy,ipsilateral total lobectomy combined with isthmusectomy plus contralateral subtotal lobectomy or total thyroidectomy,and ipsilateral or bilateral central compartment（level VI） lymph node dissection.The patients with enlarged cervical lymph nodes and suspected of having cervical lymph node metastasis before or during surgery underwent additional modified neck dissection.After surgery,all the 142 patients received replacement therapy with levothyroxine,101 cases of whom were also given radioactiv

关 键 词：甲状腺肿瘤/外科学 甲状腺结节 甲状腺癌/诊断 

分 类 号：R736.1[医药卫生—肿瘤]