桥本病并存甲状腺结节外科治疗的临床分析

Surgical treatment of thyroid nodules in patients with Hashimoto's disease, an analysis of 299 cases

目的探讨桥本病并存甲状腺结节的临床特征和外科诊治经验。方法对1985年 1月至2004年12月因发现甲状腺结节行外科手术,术后经病理证实为桥本病的299例患者的临床特征进行分析。结果桥本病并存甲状腺癌52例(17．4％),甲状腺腺瘤103例(34．4％),结节性甲状腺肿17例(5．7%),甲状腺功能低下11例(3．7％),甲状腺功能亢进7例(2．3％)。1995年以前桥本病与甲状腺癌并存患者6例,占同期手术治疗的桥本病65例的9．2％;1996年以后桥本病与甲状腺癌并存患者46例,占同期手术治疗桥本病234例的19．7％(P<0．05)。并存甲状腺癌中乳头状癌 35例,滤泡状癌11例,混合性癌4例,黏膜相关淋巴瘤1例,全组中隐匿性甲状腺癌17例,占并存甲状腺癌的32．7％。手术方式由患者具体情况并结合术中冰冻结果确定,包括一侧或双侧甲状腺全切除或次全切除、部分切除或活检术。结论桥本病与甲状腺癌、甲状腺腺瘤并存率高,其发病率近年来有明显增高趋势;应警惕桥本病并存甲状腺肿瘤特别是隐匿性甲状腺癌的可能性。

Objective To investigate the clinical characteristics and evaluate surgical experiences in Hashimoto＇s disease patients suffering from coexistent thyroid nodules. Method Clinical data in 299 cases of Hashimoto＇s disease coexistent with thyroid nodules treated surgically from Jun 1985 to Dec 2004 were analyzed. Results The coexistent rate of Hashimoto＇s disease （HD） with thyroid carcinoma （TC）, thyroid adenoma,nodular goiter, hypothyroidism and hyperthyroidism was 17. 4% , 34.4%, 5.7%, 3.7% and 2. 3% respectively. The coexistent rate of HD with TC was 9.2% before 1995, and 19.7% after 1996. There were 35 cases of papillary carcinoma, 11 cases of follicular carcinoma, 4 cases of mixed type and one case of lymphoma. There were 17 cases of occult thyroid carcinoma, accounting for 32. 7% of the malignancy. Operative procedures included biopsy only and thyroidectomy according to frozen pathology. Conclusions There is a high incidence of coexistent thyroid neoplasm in patients with Hashimoto＇s disease, the incidence of thyroid carcinoma especially occult carcinoma is rising recently.