甲状腺癌的诊断治疗
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张清华 E-mail:zqh244@126.com

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Diagnosis and treatment of thyroid cancer
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    摘要:

    目的:探讨甲状腺癌诊断及治疗方法。
    方法:回顾性分析我院2002—2008年行手术治疗的甲状腺癌患者236例的临床资料。
    结果:本组患者术前B超检查发现甲状腺内实性或囊实性结节225例(95.53%),结节内伴微钙化灶者 78例(33.05%);B超引导下细针穿刺活检81例,阳性率87.65%;术中冰冻切片检查221例,诊断甲状腺癌208例,阳性率94.11%;术后病理检查证实有淋巴结转移者为68例(28.81%)。行甲状腺部分切除15例,患侧叶全切44例,根治性切除177例。因误诊行甲状腺癌局部或患侧叶切除术后确诊行二次以上手术者25例,残癌率为 56.0%(14/25)。
    结论:B超检查提示甲状腺结节内微钙化灶对甲状腺癌诊断有重要提示意义,结合B超引导下细针穿刺活检可明显提高术前诊断准确率,术中冰冻切片检查是确诊甲状腺癌的重要方法。患叶全切+峡部全切+对侧大部切除+选择性颈清扫术是甲状腺癌的主要手术方式。对术中误诊术后确诊者应及早行二次手术。

    Abstract:

    Objective:To investigate the diagnosis and treatment of thyroid cancer.
    Methods:Retrospective analysis of the clinical data of 236 patients with  thyroid cancer who underwent surgical treatment in our hospital from 2002-2008 was conducted.
    Results:Solid thyroid nodules or cystic-solid nodules were found in 225 patients (95.53%) by B-ultrasonography (BUS)  preoperatively, among them, micro-calcification  within nodules was found in 78 cases (33.05%).  B ultrasound-guided fine-needle aspiration biopsy was performed in 81 cases, and had positive rate of 87.65%. Intraoperative frozen section was examined in 221 cases, among which 208 cases of thyroid cancer were diagnosed, a positive rate of 94.11%. Postoperative pathological examination confirmed lymph node metastasis in 68 cases (28.81%). Partial thyridectomy was performed in 15 cases, ipsilateral lobectomy in 44 cases, and radical resection in 177 cases. In 25 cases who was misdiagnosed before operation, and correct diagnosis was comfiromed by pathological examination  after partial resection or ipsilateral lobectomy, then a secondary or more surgical procedures were performed, with residual cancer rate of 56.0% (14/25).
    Conclusions:BUS finding of thyroid nodules containing micro-calcification has important significance  for thyroid cancer diagnosis, and in combination with B ultrasound-guided fine-needle aspiration biopsy could significantly improve the accuracy of preoperative diagnosis. Intraoperative frozen section diagnosis is an important method for confirmation of thyroid cancer. Ipsilateral total lobectomy+ isthmectomy+ contralateral subtotal lobectomy+ selective neck dissection is the main surgical method for thyroid cancer. For misdidanosed cases, a secondary operation should be performed as early as possible.

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张清华| 王瑞华| 卓宜盟.甲状腺癌的诊断治疗[J].中国普通外科杂志,2010,19(11):1169-1172.
DOI:10.7659/j. issn.1005-6947.2010.11.001

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  • 收稿日期:2010-05-28
  • 最后修改日期:2010-10-12
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  • 在线发布日期: 2010-11-15