结节性甲状腺肿合并甲状腺癌的诊断与治疗
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王志明E-mail:wangzhiming008@yahoo.com.cn

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R 736.1

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Diagnosis and treatment of nodular goiter with thyroid carcinoma
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    摘要:

    目的:探讨结节性甲状腺肿合并甲状腺癌的临床特点和诊治原则。
    方法:回顾性分析2005年1月—2007年12月期间收治的40例结节性甲状腺肿合并甲状腺癌患者的临床病例资料。
    结果:结节性甲状腺肿合并甲状腺癌中结节钙化的发生率(42.5%)明显高于单纯结节性甲状腺肿 (16.7%)(P<0.05);甲状腺单个结节癌变发生率(20.8%)显著高于一侧多个结节者(4.66%)(P<0.01)。仅4例术前诊断为结节性甲状腺肿合并甲状腺癌。40例患者均行手术治疗,术中常规快速冷冻病理检查,并根据病理检查结果采取不同的手术方式,包括一侧全切4例,一侧全切一侧次全切除27例,双侧次全切1例,双侧全切8例。40例患者中行一侧颈部淋巴结清扫术11例。术后未发生明显声嘶,3例术后出现抽搐或手足麻木。孤立性结节的癌变率显著高于多发性结节(P<0.05)。
    结论:对单侧孤立结节或有钙化的甲状腺结节,应高度警惕结节恶变可能,需积极手术治疗;对结节性甲状腺肿术中必须行快速冷冻切片病理检查,以明确诊断。结节性甲状腺肿合并甲状腺癌需按甲状腺癌的处理原则进行。

    Abstract:

    Objective:To investigate the diagnosis and treatment of nodular goiter with thyroid carcinoma.
    Methods:The clinical data of forty cases of nodular goiter with thyroid carcinoma admitted to our hospital from January 2005 to December 2007 were retrospectively analyzed.
    Results:Among the 40 cases, only four cases were preoperatively diagnosed as nodular goiter with thyroid carcinoma. All cases received operation and the diagnosis were comfirmed by frozen section examination. Various modes of thyroidectomy were performed according to the pathological results, including four cases had unilateral total thyroidectomy, 27 had unilateral total thyroidectomy combined with opposite subtotal thyroidectomy, one case had bilateral subtotal thyroidectomy, and eight cases of bilateral total thyroidectomy. Of all 40 cases, 11 cases received unilateral cervical lymph node dissection. There were only three cases occurred convulsion or numbness, and no hoarseness occurred postoperatively. Compared to simple nodular goiter, the incidence of calcification in nodular goiter with thyroid carcinoma was significantly increased (P<0.05). The incidence of carcinoma in single thyroid nodules was higher than that in unilateral multiple nodules(P<0.01).
    Conclusions:When an unilateral solitary nodule or a thyroid nodule with calcification is found, the possibility of malignancy should be highly considered and aggressive surgery is mandated. The patients with nodular goiter suspected of thyroid carcinoma should have intraoperative frozen section examination to confirm the diagnosis. Nodular goiter with thyroid carcinoma should be treated according to the  principles of thyroid carcinoma.

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张鸽文| 朱斯维| 王志明.结节性甲状腺肿合并甲状腺癌的诊断与治疗[J].中国普通外科杂志,2010,19(5):467-470.

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  • 收稿日期:2009-12-05
  • 最后修改日期:2010-02-05
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  • 在线发布日期: 2010-05-15
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