中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (02): 127-129.

• 论著 • 上一篇    下一篇

桥本甲状腺炎183例外科治疗分析

吴玲燕，徐少明，王    平，李志宇   

  1. 浙江大学医学院附属第二医院 国际保健中心，浙江杭州 310009   
  • 出版日期:2010-02-01 发布日期:2010-03-11

  • Online:2010-02-01 Published:2010-03-11

PDF

摘要：

目的    总结桥本甲状腺炎（HD）及其并存病的外科诊治经验。 方法    回顾分析1999年1月至2007年10月浙江大学医学院附属第二医院经手术后病理证实183例HD病人的临床资料。 结果    183例均经手术治疗。其中单纯HD 104例，HD合并甲状腺癌49例（26.7%，其中局部癌变5例，微小乳头状癌32例，直径>1.0cm的甲状腺乳头状癌12例），HD合并结节性甲状腺肿15例（8.2%），HD合并腺瘤样结节8例（4.4%），HD合并Graves病7例（3.8%）。手术方式据病变部位及性质和术中冰冻切片而定。以术后病理诊断为标准，术前诊断HD的正确率为78.7%，诊断甲状腺癌为53.1%；术中FS诊断HD的正确率为95.6%，诊断甲状腺癌为95.9%。1例微小乳头状癌行双侧甲状腺次全切除术后2年局部复发，1例HD行双侧甲状腺次全切术后4年结节复发，余无复发和转移现象。 结论    综合应用临床查体，自身抗体检测及影像学检查等资料有助于提高HD的术前诊断正确率；HD合并其他甲状腺疾病的发生率高，应警惕并存甲状腺癌，特别是微小癌的可能性。

关键词: 桥本甲状腺炎, 甲状腺癌

Abstract:

Surgical treatment for Hashimoto diseases: an analysis of 183 cases        WU Ling-yan, XU Shao-ming, WANG Ping, et al. The Second Hospital Affiliated to ZheJiang University, HangZhou 310009, China
Corresponding author：LI Zhi-yu, E-mail：yugehdh@163.com
Abstract    Objective    To explore the diagnosis and treatment of Hashimoto disease(HD) and its complications. Methods    The clinical data of 183 cases of pathology proved HD admitted between January 1999 and October 2007 at the Second Hospital Affiliated to Zhejiang University were analyzed retrospectively. Results    All the cases received surgeries. Among them, 104 cases were simple HD. Forty-nine cases were found also suffering from thyroid carcinoma besides HD (with a concurrent rate of  26.7%), and 15 from thyroid nodules (8.2%), 8 from thyroid adenoma (4.4%), 7 from Graves disease (3.8%). The way of surgeries were decided by the location and results of FS. According to the final pathological report, the accuracy of diagnosis about HD before surgeries was 78.7%, about TC was 53.1%. The accuracy of diagnosis about HD according to FS was 95.6%, and about TC was 95.9%. All the cases were followed up for an average period of 3.8 years. One of the PTMC suffered local recurrence 2 years after sub-resection of both sides of thyroid tissue. Another of HD was found recurrence 4 years after surgery. All other cases were all alive without recurrence. Conclusion    The diagnosis of HD depends on analysis of clinical feature, examination of serum antibodies, and FNAC or frozen section in operation. HD is likely to have complications. It should pay attention to TC, especially PTMC.

Key words: Hashimoto diseases, thyroid carcinoma