桥本病并发其他甲状腺疾病外科治疗探讨

Surgical treatment of Hashimoto is disease complicated with other concurrent thyropathy

目的总结桥本病并发其他甲状腺疾病的手术治疗经验。方法1984-2003年手术治疗189例桥本病,对其中76例并发甲状腺其他疾病的桥本病进行回顾性分析。结果76例均并发甲状腺结节,其中桥本病并存甲状腺癌24例(31.58%),淋巴瘤3例(3.95%),甲状腺腺瘤8例(10.53%),甲状腺机能亢进2例(2.63%),结节性甲状腺肿38例(50.00%),淋巴组织非典型增生1例(1.32%)。根据病理检查采取了不同范围的手术方式。术后均服用甲状腺素片,并随访。因患淋巴瘤死亡1例,甲状腺功能低下3例。结论对于合并甲状腺结节的桥本病应行手术治疗,术中快速病理检查是获得正确诊断的有效方法,利于选择适当的手术方式,手术中应尽量保留正常的甲状腺组织,防止甲状腺功能低下。

Objective To sum up the experience on surgical treatment of Hashimoto＇ s disease complicated with other concurrent thyropathy. Methods The clinical data were analyzed on 76 cases of Hashimoto＇ s disease（HD） surgically found to have other concurrent thyropathy out of 189 HD cases undergoing surgery. Results Thyroid nodules were found in all 76 HD cases,among which 24 were with thyroid cancer,3 with malignant lymphoma,8 with thyroid adenoma,2 with hyperthyroidism,38 with nodular goiter,and 1 with non-typical hyperplasia of lymph tissue. Thyroidectomy of different extent was performed according to pathological results. Postoperatively all cases were given thyroxine. On follow up a patient with malignant lymphoma died,and three patient suffered hypothyroidism. Conclusion HD cases complicated with thyroid nodules should be treated surgically. Intraoperative frozen section is a reliable diagnostic method and may guide the surgical modality. The normal thyroid tissue should be maintained as more as possible during operation in order to avoid the postoperative hypothyroidism.