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目的探讨甲状腺肉瘤的诊断与治疗。方法回顾性分析2008年1月至2013年8月期间贵阳医学院附属医院甲状腺外科和贵州肿瘤医院甲状腺外科收治的5例甲状腺肉瘤患者的临床资料。结果 5例患者均行根治性手术,3例行术后化疗及放疗。术后均未发生声音嘶哑、呼吸困难、呛咳、肺部感染等并发症,切口均甲级愈合。经病理学免疫组化检查,具体分型为甲状腺组织细胞肉瘤1例,甲状腺血管肉瘤2例,甲状腺平滑肌肉瘤1例,甲状腺未分化肉瘤1例;波形蛋白(Vimentin)阳性5例,角蛋白(CK)阳性2例,平滑肌肌动蛋白(SMA)、结蛋白(Des)及S-100各阳性1例,甲状腺球蛋白(TG)、上皮膜抗原(EMA)、甲状腺转录因子(TTF)及降钙素均为阴性。术后5例患者均经电话随访,随访时间3~9个月,中位数为6个月。随访期间,3例患者因复发和转移而死亡;余2例仍在化疗及放疗中,无复发及转移。结论甲状腺肉瘤的恶性程度高,宜采用以手术为主的综合治疗方案。
Objective To investigate the diagnosis and treatment of thyroid sarcoma. Methods The clinical data of 5 cases of thyroid sarcoma treated at the Department of Thyroid Surgery, Affiliated Hospital of Guiyang Medical College and Thyroid Surgery of Guizhou Cancer Hospital from January 2008 to August 2013 were retrospectively analyzed. Results All 5 patients underwent radical surgery, and 3 patients underwent postoperative chemotherapy and radiotherapy. No postoperative complications such as hoarseness, dyspnea, cough, and lung infection occurred. All incisions healed. Immunohistochemical examination of pathology showed that there were one case of thyroid tissue cell sarcoma, two cases of thyroid angiosarcoma, one case of thyroid leiomyosarcoma, one case of thyroid undifferentiated sarcoma, five cases of Vimentin positive, and keratin ( CK) positive in 2 cases, smooth muscle actin (SMA), Des protein (Des) and S-100 positive in 1 case, thyroglobulin (TG), epithelial membrane antigen (EMA), thyroid transcription factor (TTF) and drop All calcium is negative. All 5 patients were followed up by telephone. The follow-up time was 3 to 9 months, with a median of 6 months. During the follow-up period, 3 patients died of recurrence and metastasis; the remaining 2 patients were still undergoing chemotherapy and radiotherapy without recurrence and metastasis. Conclusion The malignant degree of thyroid sarcoma is high, so it is better to adopt a comprehensive treatment plan based on surgery.