淋巴细胞性甲状腺炎合并甲状腺乳头状癌的临床分析  

Clinical analysis of lymphocytic thyroiditis coexistent with papillary thyroid carcinoma

作　　者：王士旭 佘志强[2] 安常明[1] 张溪微[1] 李正江[1] 唐平章[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院头颈外科,100021 [2]广西中医药大学附属瑞康医院耳鼻咽喉头颈外科,南宁530001

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第4期277-281,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 探讨淋巴细胞性甲状腺炎（lymphocytic thyroiditis,LT）合并甲状腺乳头状癌（papillary thyroid carcinoma,PTC）的诊断及处理原则.方法 回顾性分析中国医学科学院北京协和医学院肿瘤医院头颈外科同—治疗组2011年9月至2014年9月初治的LT合并甲状腺结节病例292例,其中男25例,女267例.依据不同的病理类型分为两组,其中LT合并PTC患者262例,中位年龄47岁.术前超声诊断为恶性或可疑恶性259例,良性3例;考虑多灶恶性结节者98例,颈部淋巴结转移者112例,其中考虑双颈淋巴结转移37例.LT合并良性结节患者30例,中位年龄为54岁,术前超声诊断为恶性或可疑14例,良性16例.以SPSS 20软件行统计学分析.结果 262例LT合并PTC患者与良性组相比,前者发病年龄较轻,在超声上粗大钙化比例均较高,分别为34％和13％,差异具有统计学意义（P＜0.05）.恶性组中血清促甲状腺激素（thyroid stimulating hormone,TSH）平均浓度为2.80 mU/L、甲状腺球蛋白（thyroglobulin,TG）平均浓度为27.14 μg/L、抗甲状腺球蛋白抗体（anti-thyroglobulin antibodies,ATG）平均浓度为417.3 U/ml,良性组中TSH、TG、ATG分别为2.99 mU/L、18.60 μg/L、378.7U/ml,经统计分析P值为0.233、0.747、0.834,差异均无统计学意义.在LT合并PTC患者中,多病灶患者占42％,中央区淋巴结转移率达50％,侧颈淋巴结转移率为24％.单因素分析结果显示,年龄＜45岁、多中心病灶、肿瘤直径＞2cm及有腺外侵犯患者发生中央组淋巴结转移概率较高（P＜0.05）,在侧颈淋巴结转移方面则差异无统计学意义.多因素Logistic回归分析结果显示,仅Ⅵ区淋巴结转移与侧颈淋巴结转移有关（P＜0.05）.结论 血清TSH、TG和ATG在LT合并PTC的鉴别诊断中帮助不大,粗大钙化在LT合并PTC的超声诊断中具有重要意义,应引起重视.多发病灶及单个病灶合并低回声良性结节患者建议行甲状腺全切除＋中央区淋巴结清扫Objective To analyse the clinical features and treatment strategies of papillary thyroid carcinoma（PTC） coexistent with lymphocytic thyroiditis （LT）.Methods A total of 292 patients including 25 males and 267 females with LT and thyroid nodules treated in the department of head and neck surgery between Sep 2011 and Sep 2014 was analysed retrospectively and divided into two groups according to pathological results,of them 262 patients,with a median age of 47 years old,were LT with PTC and 30 patients,with a median age of 54 years old,were LT with benign nodules.Among 262 patients having LT with PTC,259 were diagnosed as having malignant or suspicious malignant nodules and 3 having benign nodules with ultrasound before surgery,98 cases were considered multifocal malignant nodules by preoperative ultrasound,and 112 cases were positive in cervical lymph nodes,including bilateral positive in 37 cases.Of 30 patients having LT with benign nodules,14 were diagnosed malignant or suspicious malignant nodules and 16 benign nodules.Results The mean age in 262 patients with PTC was less significantly than that in 30 patients with benign nodules （P 〈 0.05）.Ultrasound showed a high proportion of calcification and microcalcification in patients with PTC （34%） compared to patients with benign nodules （13 %） （P 〈 O.05）.There were not significant differences in the mean levels of serum thyroid stimulating hormone（TSH） （2.80 vs 2.99 mU/L,P =0.233）,thyroglobulin（TG） （27.14 vs 18.60 μg/L,P =0.747）,and anti-thyroglobulin antibodies （ATG） （417.3 vs 378.7 U/ml,P =0.834） between patients with PTC and those with benign nodules.In patients with PTC,multifocal tumor accounted for 42%.The central and lateral lymph node metastasis rates were respectively 50% and 24%,and the occult metastasis rate of lateral neck lymph node was 16%.Univariate analysis showed that age less than 45 years old,multifocal tumor,tumor diameter more than or equal to 2cm and extrathyroidal extension were associated wi

关 键 词：甲状腺炎 自身免疫性 甲状腺肿瘤 诊断 处理 

分 类 号：R581.4[医药卫生—内分泌]