年轻女性甲状腺癌的临床分析

A clinical analysis of thyroid carcinoma in young females

目的探讨年轻女性甲状腺癌的临床特点,以期提高对该疾病的诊治水平。方法回顾性分析近10年连续收治的74例年轻甲状腺癌患者的临床资料,术前体检大多数甲状腺结节无质硬和固定的表现。术前患者均行B超检查,其中有61例患者(82.43%)B超示多发性结节;43例行同位素检查,有41例发现甲状腺结节,其中冷、凉和温结节分别为14,18,9例;11例行细针穿刺细胞活检,2例阴性,1例提示细胞有异型,3例提示癌疑,5例提示乳头状癌。结果病理检查70例为甲状腺乳头状癌,3例为滤泡状癌,1例为髓样癌,且大多数患者同时伴有其他甲状腺良性疾病;有28例(37.84%)出现颈部淋巴结转移,与同期中老年女性甲状腺癌颈淋巴结转移率16.46%(27/164)相比,差异有显著性(P<0.05)。有2例于术后3年内因远处转移而死亡。结论年轻女性甲状腺癌患者易发生淋巴结转移;结节的质地和活动度不应作为判断其良恶性的手段;应对B超发现的结节进行细化,对直径>1.0cm的实质性结节建议行手术治疗,对直径>2.0cm的混合性结节须行同位素和细针穿刺细胞活检检查,以免漏诊。

Objective To study the clinical characteristics of thyroid carcinoma in young females, in order to improve the diagnosis and treatment of this disease. Methods The clinical data of 74 consecutive young female patients with thyroid carcinoma treated in our hospital in the recent ten years were analysed. In most of the cases, there was no firm texture or fixation of the thyroid nodules to surrounding structures on physical examination before operation. Ultrasonography was performed in all patients and multiple thyroid nodules were found in 61 cases （ 82.43 % ）. Thyroid scintiscans were performed in 43 cases, and thyroid nodules were found in 41 cases. The cold, cool and warm nodules were found in 14,18 and 9 cases, respectively, by scintiscans. Fine needle aspiration biopsy （ FNAB ） was performed in 11 cases, and in 2 cases were negative, 1 case showed abnormal cell, 3 cases were suspicious of carcinoma, and 5 cases were confirmed papillary carcinoma. Results Papillary carcinoma was found in 70 cases, follicular carcinoma in 3 cases and medullary carcinoma in 1 case by histological examination, and benign disease was also accompanied in most cases. Lymph node metastases was found in 28 cases （37. 84% ）, and the rate of metastases was significantly different than that of older female patients （ 16.46 % ） at the same time. There were 2 cases who died 3 years after operation because of metastases. Conclusions The lymph node metastases were prevalent in young female patients with thyroid carcinoma. The texture and mobility of the nodules cannot be used to differentiate benign from malignant nodules. We should carefully analyze every nodule found on ultrasonography, For the solid nodules with diameter larger than 1.0cm, we suggest operation ; for the nonsolid nodules with diameter larger than 2.0cm, we prefer scintiscans and FNAB for diagnosis.