桥本甲状腺炎的外科诊疗体会(附98例报告)

The diagnosis and surgical treatment of Hashimoto’s thyroiditis (a report of 98 cases)

目的:总结桥本甲状腺炎的诊断与外科治疗经验。方法:回顾性分析我院2003年5月至2007年6月行手术治疗的98例桥本甲状腺炎的临床资料。结果:术前B超检查发现95例中有甲状腺结节,其中32例结节内伴钙化。术前穿刺细胞学检查发现,15例示甲状腺癌,26例示细胞增生活跃,11例为结节性甲状腺肿,2例为甲状腺腺瘤,1例为淋巴瘤,40例为桥本甲状腺炎,3例为毒性甲状腺肿。而术后病理检查结果示,42例为单纯性桥本甲状腺炎;桥本甲状腺炎伴甲状腺癌、结节性甲状腺肿、甲状腺腺瘤及淋巴瘤者分别为49、4、2及1例。结论:桥本甲状腺炎术前,应行颈部B超、穿刺细胞学及甲状腺免疫功能检查;诊断不明者需行术中冷冻病理检查,为选择合适的术式提供依据。

Objective To summarize the experience in the diagnosis and surgical treatment of Hashimoto＇s thyroiditis. Methods The clinical data from 98 cases of Hashimoto＇s thyroiditis, which underwent operation in our hospital from May 2003 to June 2007, were retrospectively analyzed. Results By preoperative B-type ultrasonography, nodules were detected in 95 cases; among 32 of the cases calcification was found in the nodules. The results of preoperative fine needle biopsy were as following： 15 cases of thyroid cancer, 26 cases of active cellular proliferation, 11 cases of nodular goiter, 2 cases of adenoma, 1 case of lymphoma, 40 cases of Hashimoto＇s throiditis, and 3 cases of toxic goiter. Yet, the postoperative pathological findings demonstrated that there were 42 cases of simple hashimoto＇s disease; the numbers of patients with Hashimoto＇s disease concomitant with thyroid cancer, nodular goiter, thyroid adenoma, and lymphoma were 49, 4, 2, and 1 respectively. Conclusions Pre-operative cervical B-type ultrasonography, fine needle aspiration biopsy and thyroid hormone parameters should be performed in patients suspected of Hashimoto＇s thyroiditis. Intraoperative frozen-section biopsy is necessary to guide the adoption of optimal operative procedures.