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目的探讨结节性甲状腺肿合并甲状腺癌的诊治方法。方法回顾性分析我院2000年1月至2006年12月手术治疗的635例结节性甲状腺肿病例中38例并存甲状腺癌患者的临床资料。结果同期手术治疗结节性甲状腺肿患者635例,合并甲状腺癌38例(5.98%),病理检查结果:微小癌变17例,双叶癌7例,乳头状癌23例,滤泡状癌7例,髓样癌4例,未分化癌3例,甲状腺肉瘤样伴鳞癌分化1例,所有患者均行术中快速冷冻病理检查,并根据病理检查结果采取不同的手术方式。结论结节性甲状腺肿术前检查怀疑甲状腺癌者应行细针穿刺及术中快速冰冻切片病理检查有利于确诊,可有效避免再次手术;甲状腺全切+131I放射治疗残余灶和/或转移灶+足量L-型甲状腺素钠抑制治疗有利于降低复发和死亡。
Objective To investigate the diagnosis and treatment of nodular goiter complicated with thyroid cancer. Methods The clinical data of 38 patients with thyroid cancer who underwent surgery in our hospital from January 2000 to December 2006 were analyzed retrospectively. Results There were 635 cases of nodular goiter and 38 cases of thyroid adenocarcinoma with concurrent thyroidectomy. The pathological findings included 17 cases of small canceration, 7 cases of bilobal carcinoma, 23 cases of papillary carcinoma and 7 cases of follicular carcinoma 4 cases of medullary carcinoma, 3 cases of undifferentiated carcinoma and 1 case of thyroid sarcoma with squamous cell carcinoma. All the patients underwent rapid intraoperative frozen pathological examination and adopted different surgical methods according to the pathological findings. Conclusion Nodular goiter preoperative examination of suspected thyroid cancer should be fine needle aspiration and intraoperative rapid frozen section pathological examination is conducive to diagnosis, which can effectively avoid reoperation; thyroidectomy + 131I radiation treatment of residual lesions and / or metastases L-type thyroxine sodium suppressive therapy is beneficial to reduce recurrence and death.