桥本病诊断与外科治疗

Expression in Diagnosis and Surgical Management for Hashimoto's Thyroiditis (Report of 57 Case)

目的总结和进一步探讨桥本病诊断经验与处理程序。方法收集杭州市第一人民院1996年1月～2006年12月间共收治的临床诊断为桥本病的57例患者的临床资料。结果女性50例,男性7例,年龄17～68岁,平均43.6岁,男女比例为1∶14,其中合并甲状腺肿瘤者占10.5%,合并甲状腺腺瘤者占19.3%,合并甲亢者占14.0%,合并其他自身免疫性疾病者占21.1%,合并其他疾病者占8.8%,其中手术者占33.3%,误诊率为21.1%,漏诊率为22.8%。结论一旦怀疑桥本病,应采取多种综合检查手段,包括B超,甲状腺素T3、T4,甲状腺扫描,甲状腺微粒体抗体及甲状腺球蛋白抗体,细胞学穿刺检查,肿块活检等检查进行综合判断,处理上多采取保守治疗,对有合并症者应采取综合治疗措施,不宜孤立分析和处理,对同疾病也应分时期并根据临床特点做相应处理,才能提高诊断率和疗效,避免漏诊和不必要的损伤。

Objective To sum up and investigate the experience in diagnosis and therapeutic procedure for Hashlmoto＇ s disease （HD）. Methods Clinical datas of 57 patients who were diagnosed clinically as HD admitted to First People＇ s Hospital of Hangzhou from Jan 1996 to Dec 2006 were collected and analyzed. Results 50 females and 7 males ,aged 12 to 68 years （average of 43.6 years）. Rate of male to female is 1： 14,HD was coexistent with 10.5% （6/5 7） of thyoidgland malignant tumor 19.3% （11/57） of adenoma,14. 0% （8/57） of hyperthyroidism,21.1% （ 11/57 ） of other systemtic autoimmunlty disease and 8.8% （5/57） other rare disease 33.3% （ 19/ 57） of them were performed raical operation . The misdiagnosis rate was 21.1% （ 12/57 ） and missed diagnosis rate was 22.8% （13/57） , The clinical feature of HD for diagnosis and surgical management procedure have been discussed. Conclusions It is emphasized that patients who suspected highly of having HD should be examinated by comprehensive methods,lncluding B - us,lightly color on scintillation scintigraphy,elevation of antimicrosomiauxi and antithyoglobullne , FNAB,operative exploration and biopsy would be helpful . We suggest that the diagnosis of HD may be taken some routinely comprehensive procedure . To date , consecutive therapy and occationly some patients when the disease in coexistence ,who ought to be operated correspondingly.