桥本氏和亚急性甲状腺炎临床诊断及外科手术治疗的探讨  

Clinical Diagnosis and Surgical Treatment of Hashimoto's Thyroiditis and Subacute Thyroiditis

作　　者：王烯冬[1] 迟宝恩[2] 李利宁[1] 白志刚[1] 夏医君[1] 梁越[1] 

机构地区：[1]内蒙古自治区医院普外科,内蒙古呼和浩特010017 [2]内蒙古医学院附属医院普外科,内蒙古呼和浩特010050

出　　处：《内蒙古医学杂志》2004年第1期1-6,共6页Inner Mongolia Medical Journal

摘　　要：目的 :总结分析桥本氏、亚急性甲状腺炎临床诊断和治疗经验及影响诊断的相关因素。方法 :回顾 1994～ 2 0 0 0年我院及内蒙古医学院附属医院收治的桥本氏甲状腺炎 (HT) 5 2例 ,亚急性甲状腺炎 (SAT)4 8例 ,对其发病、临床表现、诊断以及外科手术治疗进行分析。结果 :5 2例HT和 4 8例SAT各有 2例临床作出甲状腺炎诊断。除 2例HT和 3例SAT活检术外 ,其余病例均接受手术治疗。与病理检查对照 ,术前误诊率很高 ,HT为 96 15 % ,SAT为 95 83% (P >0 0 5 )。术后甲低功发生率HT为 2 0 % ,SAT为 17 14 %(P >0 0 5 )。HT并发甲亢 (GD) 5例 (占 12 5 % ) ,甲状腺癌 (TC) 2例 (占 5 % ) ,SAT并发GD和TC均为 0例 (0 0 1<P <0 0 5 )。结论 :桥本氏、亚急性甲状腺炎女性多于男性 ,中年好发 ;正确掌握其临床特征 ,常规HT测血清抗体 (TGA ,TMA) ,SAT作核医学检查 ,有选择地作细针抽吸细胞学检查 (FNAB) ,注意与其它甲状腺疾病鉴别可降低术前误诊率 ;重视并发恶性肿瘤 ;术中常规作冰冻切片检查 ,利于选择正确的手术方法 。Objective:To sum up the clinical experience in diagnosis and treatment of Hashimoto's Thyroiditis (HT)and subacute thyroidities(SAT)and analyze the related factors with diagnosis.Methods:52 cases of HT and 48 cases of SAT were reviewed from 1994 to 2000.Their genesis,Clinical manifestation,diagnosis and operative treatment were analyzed.Results:2 HT and 2 SAT were respectively misdiagnosed as Thyroiditis.Expect for 2 HT and 3 SAT confirmed by biopsy,all cases were treated with surgical operations.Compared with pathological diagnosis,the misdiagnosis rate before operation was much higher (96.15% in HT,95.83% in SAT,P>0 05).The postoperative incidence of hypothyroidism was 20% in HT and 17.14% in SAT (P>0 05).There were 5 cases (12.5%)complicated with hyperthyroidism,2 cases (5%) with thyroid cancer in HT,and non was found in SAT.Conclusions:HT and SAT are present more in middle ages and female cases.It will reduce the preoperative misdiagnosis rate through the Study of Clinical features combined with determination of serum autoimme antibodies in HT,nuclear medical tests in SAT, selective tests of fine needle aspiration biopsy(FNAB) and the differential diagnosis with other thyrloid diseases.Taking routine examination of intraoperative frozen section is helpful to proper operation and effective treatment.

关 键 词：桥本氏 亚急性甲状腺炎 误诊 

分 类 号：R653.2[医药卫生—外科学] R581.4[医药卫生—临床医学]