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目的探讨结节性甲状腺肿(结甲)合并甲状腺癌(甲癌)的临床特点和外科诊治方法。方法回顾性分析2008年1月—2011年1月收治的1 859例结甲中142例(7.6%)合并甲癌患者的临床资料。结果 142例均行手术治疗。112例为初次手术,30例为二次(补充)手术。男∶女=1∶3.1,临床表现以结甲表现为主。术前超声检查疑诊合并甲癌55例(38.7%),其中结节砂砾钙化21例。12例伴颈部淋巴结肿大。90例行高分辨率彩色多普勒超声检查,75.6%(68/90)疑有恶性病变。45例行细针穿刺细胞病理学检查(FNA),确诊率48.9%(22/45)。138例术中冷冻切片快速病理诊断准确率96.4%,假阴性5例,无假阳性病例。甲癌83例为单发癌灶,59例为多发癌灶,病灶<2 cm者占75.3%。病理类型以乳头状癌为主(75.4%)。64例伴淋巴结转移。手术方式包括:患侧腺叶+峡部全切除术;患侧腺叶+峡部+对侧腺叶次全切除术或甲状腺全切除术和同侧或双侧中央区(VI区)淋巴结清扫;颈部淋巴结肿大和术中或术前怀疑颈部淋巴结转移者加行改良颈清扫术。142例术后均予以左旋甲状腺素治疗,101例行131I治疗。术后随访6个月至3年,8例患者复发并进行2次手术治疗,1例由于甲状腺癌肺转移死亡。结论结甲合并甲癌以乳头状癌为主,病灶以<2 cm多见。术前超声、FNA和术中冷冻切片快速病理检查可提高结甲合并甲癌的检出率,有效避免漏诊误诊。对结甲患者加大跟踪随访强度可提高合并甲癌的早期检出率。
Objective To investigate the clinical features and surgical diagnosis and treatment of nodular goiter (tuberculosis) combined with thyroid cancer (A). Methods The clinical data of 142 patients (7.6%) with carcinoma of the A-arm who were treated from January 2008 to January 2011 were analyzed retrospectively. Results 142 patients underwent surgical treatment. One hundred and two patients underwent primary surgery and thirty patients underwent secondary surgery. Male: Female = 1: 3.1, the clinical manifestations to the performance of the main knot. 55 cases (38.7%) were suspected of combined diagnosis of thyroid carcinoma before operation and 21 cases of calcification of nodules. 12 cases with cervical lymph node enlargement. 90 cases of high-resolution color Doppler ultrasound, 75.6% (68/90) suspected malignant lesions. 45 cases of fine needle aspiration cytology (FNA), the diagnosis rate of 48.9% (22/45). 138 cases of intraoperative frozen section rapid pathological diagnosis accuracy rate of 96.4%, false negative in 5 cases, no false positive cases. A carcinoma of 83 cases of single foci, 59 cases of multiple foci, lesion <2 cm accounted for 75.3%. The main pathological type of papillary carcinoma (75.4%). 64 cases with lymph node metastasis. Surgical methods include: ipsilateral lobectomy + isthmic resection; ipsilateral ipsilateral lobes + isthmus + lateral lobectomy or total thyroidectomy and ipsilateral or bilateral central region (lymph node dissection); neck Department of lymph nodes and intraoperative or preoperative suspected cervical lymph node metastasis plus modified neck dissection. 142 cases were treated with levothyroxine, 101 cases of 131I treatment. All the patients were followed up for 6 months to 3 years. Eight patients relapsed and underwent two surgeries and one died of lung metastasis from thyroid cancer. Conclusion The most common form of tuberculous meningitis with papillary carcinoma is more common than <2 cm. Preoperative ultrasound, FNA and intraoperative frozen section rapid pathological examination can increase the detection rate of tuberculosis combined with carcinoma, effectively avoiding misdiagnosis. Increased follow-up intensity of patients with tuberculous meningitis can improve the early detection rate of combined carcinoma of the neck.