桥本病并发甲状腺结节的外科治疗时机与方法探讨  

Timing and method of surgical treatment of Hashimoto disease combined with thyroid nodules

作　　者：岳欣[1] 方团育[2] YUE Xin;FANG Tuan-yu(Department oflnternal Medicine,Beijing United Family Hospital,Beijing 100015,China)

机构地区：[1]北京和睦家医院内科,北京100015 [2]海南省人民医院内分泌科,海口570311

出　　处：《医药论坛杂志》2018年第7期76-78,81,共4页Journal of Medical Forum

摘　　要：目的探讨存在甲状腺结节的桥本病外科治疗的时机与方法。方法选取2009年1月至2015年2月在北京和睦家医院治疗的桥本病合并甲状腺其他疾病患者268例,分析患者临床病历资料以及超声影像学特征。结果 268例患者中,桥本病合并甲状腺癌51例(19.03%),合并结节性甲状腺肿141例(52.61%),炎性结节76例(28.36%);桥本病合并炎性结节超声检查结果提示钙化、实性结节合并弥漫性病变、结节内部及周边血流增多的比例分别为19.74%、69.74%和26.32%,明显低于合并甲状腺癌患者,差异比较有统计学意义(P<0.05);桥本病合并炎性结节超声检查结果提示实性合并囊性结节、混合性结节、结节内部及周边血流减少和结节回声不均的比例分别为0.00、7.89%、25.00%和32.89%,明显低于合并甲状腺肿患者,差异比较有统计学意义(P<0.05);根据患者具体情况采取不同的手术方式,术后给予甲状腺激素替代治疗,随访期间无永久性喉返神经损伤及甲状腺功能减退。结论结节型桥本病常需手术治疗,持续规范的甲状腺激素替代治疗可降低甲状腺结节的复发;甲状腺超声在诊断桥本病合并结节中有一定的作用。Objective To investigate the timing and method of surgical treatment Hashimoto disease combined with thyroid nodules. Methods Selected from January 2009 to February 2015 in our hospital Hashimoto disease combined with thyroid diseases 268 cases,analysed the clinical medical records and ultrasound imaging features. Results Totally 268 patients,Hashimoto disease combined with thyroid cancer 51 cases（ 19. 03%）, 141 cases of nodular goiter（ 52. 61%）,inflammatory nodules 76 cases（ 28. 36%）; Hashimoto disease combined with inflammatory nodules ultrasound results suggest that calcification,solid nodules with diffuse lesions,nodules internal peripheral blood flow increasing the proportion were 19. 74%,69. 74% and 26. 32%,significantly lower than combined with thyroid cancer patients,the difference was statistically significant（ P〈 0. 05）; Hashimoto disease combined with inflammatory nodules ultrasound results suggest that the solid combined cystic nodules,mixed nodules,nodule inner peripheral blood flow reduction and nodules echo uneven proportion were 0. 00%,7. 89%,25. 00% and 32. 89%,significantly lower than the combined with goiter patients,the difference was statistically significant（ P〈 0. 05）; According to the specific circumstances of the patients to take a different approach,postoperative given thyroid hormone replacement therapy,follow-up period without permanent recurrent laryngeal nerve injury and thyroid dysfunction. Conclusion Nodular Hashimoto ＇s disease often require surgery,continued regulate thyroid hormone replacement therapy can reduce the recurrence of thyroid nodules; Thyroid ultrasound has a certain role in the diagnosis of Hashimoto disease combined with nodules.

关 键 词：甲状腺结节 桥本病 外科手术 

分 类 号：R563[医药卫生—呼吸系统]