桥本甲状腺炎并发甲状腺乳头状癌40例临床分析

Clinical analysis of Hashimoto's thyroiditis coexisted papillary thyroid carcinoma:an analysis of 40 cases

目的分析桥本甲状腺炎并发甲状腺乳头状癌的临床特征、诊断、治疗及预后情况。方法回顾性分析1998年6月至2005年10月经病理证实为桥本甲状腺炎并发甲状腺乳头状癌40例,对其甲状腺功能指标、诊断及手术治疗进行分析。结果桥本甲状腺炎并发甲状腺乳头状癌占同期291例经病理证实为桥本甲状腺炎的13.8%(40/291)。40例中7例发生淋巴结转移(7/40),随访发现对侧甲状腺乳头状癌1例,经再次手术无复发,其中7例病人随访5年以上,至今均存活。结论桥本甲状腺炎并发甲状腺乳头状癌的发生率呈上升趋势;对于合并自身甲状腺抗体阳性的中青年女性桥本甲状腺炎病人,甲状腺不规则结节性肿大发生癌变的发生率大于弥漫肿大者;桥本甲状腺炎并甲状腺乳头状癌淋巴结转移率低,总体预后好。

Objective To analyze the clinical features and the experience in diagnosis,treatment and prognosis of Hashimoto＇s thyroiditis （HT） coexisted thyroid papillary carcinoma （PTC）. Methods A retrospective analysis of 40 HT coexisted PTC patients detected in 291 HT were undertaken. The incidence, age of onset, sex, functional parameters of thyroid,diagnoses, and therapeutic principle of surgery had been studied. Results The rate of HT coexisted PTC was 13.8% （40/291 ）. All patients were received surgery, and 7 patients had lymph node metastasis, and 1 patient had another lobe PTC and received second operation, and 7 patients received 5 years follow-up and the 5-year survival were 100%. Conclusion The incidence rate of HT coexisted PTC increases more recently. Young-middle adult woman suffering from HT mixed with single and bilateral nodule should be suspicious of malignant thyroid carcinoma. Compared with PTC, the meto static ratio of lymph node is lower and the prognosis of patients are better in HT coexisted PTC.