415例结节型桥本氏甲状腺炎的诊断和外科治疗的经验和教训  

The clinical dianogsis and surgical treatment of hashimoto's thyroiditis complicated with thyroid nodes

作　　者：杨传盛[1] 黄湛[1] 王美姣[1] 罗智辉[1] 雷睿文[1] 陈卓荣[1] 欧林洋 李敏[1] 张诠[2] 

机构地区：[1]粤北人民医院头颈乳腺外科,广东韶关512026 [2]华南肿瘤学国家重点实验室中山大学肿瘤防治中心头颈外科,广州510060

出　　处：《岭南现代临床外科》2016年第1期60-62,共3页Lingnan Modern Clinics in Surgery

基　　金：广东省韶关市卫生计生科研计划项目(Y16033)

摘　　要：目的探讨结节型桥本氏甲状腺炎的诊断、手术适应证及术式选择。方法资料来源于2005年1月至2014年1月在我院接受诊治的415例桥本氏甲状腺炎的完整病案病例。诊断方法通过检测甲状腺抗体;超声、CT查、同位素扫描;细针或粗针穿刺活检联合检查。所有患者均表现为甲状腺结节而进行手术治疗,根据患者结节的病变范围,主要采取甲状腺全切、患侧腺叶+峡部切除及双侧腺叶次全切除术进行治疗。结果 415例中:单纯桥本氏甲状腺炎157例,桥本氏甲状腺炎合并毒性甲状腺肿18例,合并结节性甲状腺肿146例,合并甲状腺腺瘤31例,合并甲状腺癌63例。结论桥本氏甲状腺炎临床表现缺乏特异性,应采用采取多种检查手段提高诊断的准确性,避免手术不必要手术,但疑有恶变或产生压迫症状者应积极手术。以往诊断出现结节即采取手术的方法不符合当前治疗指南。Objective To investigate the clinical dianogsis, operative indication, and surgical treatment of Hashimoto＇s disease complicated with thyroid nodes. Methods Clinical data of 415 patients with Hashimoto＇s disease complicated with thyroid nodes were retrospectively analyzed. Results The postoperative pathological results were as follow ：157 cases of simple hashimoto＇s thyroiditis,18 cases of simple hashimoto＇s thyroiditis with hyperthyroidism,146 cases of simple hashimoto＇s thyroiditis with nodular goiter,31 cases of simple hashimoto＇s thyroiditis with nodenoma, and 63 cases of simple hashimoto＇s thyroiditis with thyroid carcinoma. Conclusion Hashimoto＇s disease complicated with thyroid cancer has no typical symptoms and often complicated with other thyroid diseases. Combined examination of anti-thyroid antibodies test, color doppler imaging, CT detection, isotope scan and core / fine needle biopsy may provide accurate diagnosis. Operations should be actively performed on these cases which are likely maligmant or easily to induce compressive symptoms. Proper surgical treatment is effective for Hashimoto＇s disease complicated with nodes according to the individual conditong. Normal thyroid tissue should be retained as much as possible.

关 键 词：桥本氏甲状腺炎 甲状腺结节 诊断 外科治疗 

分 类 号：R653[医药卫生—外科学]