甲状腺囊实性皱缩结节临床特点分析  

Analysis of clinical characteristics of thyroid cystic-solid crinkled nodules

作　　者：王志宏[1] 张浩[1] 张平[1] 贺亮[1] 黄加鹏[1] 孙威[1] 张挺[1] 董文武[1] 张大林[1] 邵亮[1] 吕承洲[1] WANG Zhi-hong;ZHANG Hao;ZHANG Ping(Department of Thyroid Surgery,the First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院甲状腺外科

出　　处：《中国实用外科杂志》2020年第1期117-119,共3页Chinese Journal of Practical Surgery

基　　金：辽宁省“百千万人才工程”资助项目（No.2014921033）

摘　　要：目的分析甲状腺囊实性结节皱缩的临床特点及皱缩前后的超声和CT影像学特征,提高皱缩后甲状腺结节的诊断准确率。方法选取2018年6月至2019年6月在中国医科大学附属第一医院接受超声检查并经细针穿刺细胞学检查或手术后病理学检查证实为良性甲状腺囊实性结节病人41例。分析病人病史,分析结节皱缩前后病灶的大小、形态、回声、边界及钙化等超声图像特征和甲状腺增强CT的影像学特点,描述术中所见情况。结果41例病人均证实为结节性甲状腺肿。结节皱缩平均经历(11.52±9.56)个月。结节皱缩前最大径平均值(25.6±8.2)mm,皱缩后最大径平均值(10.2±4.1)mm。结节皱缩后均为低回声实性结节,其中35例包膜不完整,29例结节内部可见点状强回声,8例周边及内部出现环状强回声。按照TI-RADS分级系统,结节皱缩前37例为3级,3例为2级,1例4a级;结节皱缩后19例为4a级,22例为4b级。5例行手术治疗病人术前甲状腺增强CT提示结节边缘轻度强化,形成与正常腺体相隔离的不规则条带,结节内部均匀低密度,增强后强化不明显。术中见肿物包膜完整,质地不均,局灶可见胶质或钙化结构。结论病史的询问和前后超声结果的对比至关重要。皱缩的结节具有一定的超声和CT影像学特征,结合病史可与恶性结节相区分,避免过度的有创性检查及不必要的手术治疗。Objective To analyze the clinical features and ultrasonographic and CT features of thyroid cystic-solidnodules before and after crinkled,and to improve the diagnostic accuracy.Methods Forty-one patients with benignthyroid cystic-solid nodules confirmed by fine needle aspiration or surgery were enrolled in our study from June 2018 toJune 2019.The size,shape,echo,boundary and calcification of the nodules before and after crinkled were analyzed,aswell as the imaging features of thyroid enhanced CT.The records of the disease and the intraoperative findings wereanalyzed.Results All nodules were benign.The average duration of nodule shrinkage was 11.52+9.56 months.Themean maximum diameter of nodules before and after crinkled were 25.6±8.2 mm and 10.2±4.1 mm respectively.All thenodules were hypoechoic solid nodules after crinkled.Thirty-five cases had incomplete capsule of nodules after crinkled,29 cases had punctate echoes in the interior of retracted nodules after crinkled,and 8 cases had circular echoes in theperiphery and interior of nodules after crinkled.According to TI-RADS classification system,nodules were mostly ingrade 3(37/41)before crinkled,grade 4 a in 19 cases and grade 4 b in 22 cases after crinkled.Five patients underwentsurgery with thyroid enhancement CT before operation,which indicated that the edge of the nodule was slightly enhancedto irregular bands separated from the normal gland,and the nodule was homogeneous and low-density with slightlyenhancement after enhanced CT scan.During the operation,the capsule of the tumors was intact and uneven in texture,and glial or calcified structures could be seen in the focus.Conclusion It is essential to inquire about the history ofdisease and compare the results of ultrasound before and after crinkled to avoid unnecessary invasive diagnosis and surgery.Thyroid cystic-solid crinkled nodules havecertain ultrasonographic and CT features,whichcould help us to distinguish from malignant nodules.

关 键 词：甲状腺 囊实性 皱缩 超声 X线计算机体层摄影术 

分 类 号：R6[医药卫生—外科学]