慢性淋巴细胞性甲状腺炎合并甲状腺恶性肿瘤的诊断和治疗

Diagnosis and Treatment of Chronic Lymphocytic Thyroiditis Coexistent with Thyroid Malignancy

目的探讨慢性淋巴细胞性甲状腺炎(CLT)合并甲状腺恶性肿瘤的诊断和治疗原则。方法回顾性分析了40例CLT合并甲状腺癌与12例合并淋巴瘤患者的临床资料。结果本组两类肿瘤共占同期CLT住院病例的13·87%,其中甲状腺癌占10·67%,淋巴瘤占3·20%。两组患者在性别(P=0·008)、年龄(P=0·000)和B超检查结果(P=0·000)方面差异均有显著性。合并甲状腺癌组中手术以单侧腺体全切+对侧大部切除术为主,部分病例同时行功能性颈部淋巴结清扫术;合并淋巴瘤组中手术种类多,术后病例多行CHOP方案化疗。合并甲状腺癌组中37例患者平均随访(35·51±39·84)个月,1例于术后72个月死于肿瘤播撒,其余36例平均存活时间为(34·50±39·91)个月;合并淋巴瘤组中12例患者平均随诊(39·50±29·00)个月,2例死于肿瘤播撒,其余10例平均存活时间为(44·70±28·78)个月。结论CLT合并恶性肿瘤的情况并不少见,合并癌占多数。合并甲状腺癌组与合并淋巴瘤组在临床表现、诊断和治疗方面有很大差别。对于CLT患者,合并的甲状腺结节或甲状腺肿短期内明显增大,以及B超提示单发实性结节或结节合并钙化时,应行手术。

Objective To explore the principles of diagnosis and treatment of chronic lymphocytic thyroiditis （CLT） coexistent with thyroid malignancy. Methods The clinical data of 52 patients with CLT, ineluding clinicopathologic features, treatment, and prognosis were retrospectively analyzed. Among these 52 patients, 40 patients had coexisting thyroid carcinoma （TC group） and 12 had coexisting thyroid lymphoma （TL group）. Results These two thyroid malignancies accounted for 13.87% of all the CLT inpatients during this period, in which 10.67% were CLT with carcinoma and 3.20% were CLT with lymphoma. Significant differences existed between TC group and TL group in sex （ P = 0. 008 ） , age （ P = 0. 000 ） , and B-mode ultrasound findings （ P = 0. 000）. Most patients in TC group received total lobectomy of one lobe and subtotal lobectomy of the other side, of which some received elective lymphadenectomy. The operations varied among patients in TL group, and most of them received chemotherapy after surgery. The median follow-up was （ 35.51 ± 39.84） months for 37 patients in TC group, and 36 patients survived with a median period of （34.50 ± 39.91 ） months; the median follow-up was （39.50±29.00） months for 12 patients in TL group, and 10 patients survived with a median period of （44.70±28.78 ） months. Conclusions CLT with thyroid malignancies are not uncommon in clinical practice. While thyroid carcinoma accounts for majority of these malignancies, its clini propriate for nodules with copathologic features, treatment, and prognosis differs with thyroid lymphoma. Surgery may be ap-CLT patients calcification with rapid thyroid enlargement or nodule, and for patients with solitary solid nodule or revealed by B ultrasound.