桥本病合并甲状腺癌的诊治体会

Hashimoto＇s disease concomitant with thyroid carcinoma

目的探讨桥本病合并甲状腺癌的诊断和治疗方法。方法回顾分析74例桥本病合并甲状腺癌的临床资料。结果2002年1月—2009年8月共收治252例桥本病，其中74例为桥本病合并甲状腺癌，均为乳头状癌，其中56例TGAb升高，68例McAb升高，74例TPOAb升高。手术行患侧甲状腺全切除、峡部切除加对侧次全切除术45例，双侧甲状腺近全切除术1例（峡部癌），26例微小癌行甲状腺次全切除术或一侧腺叶全切除，2例双侧癌行双侧甲状腺全切除。所有病例同时行中央区淋巴结清扫，中央区淋巴结转移率20／74（27％）。10例因患侧颈淋巴结转移行一侧颈部淋巴结改良清扫术。69例获得随访，随访时间1个月-7年，中位随访时间29个月。4例患者因发生一侧颈淋巴结转移而再次入院行改良颈淋巴清扫术。结论TGAb、McAb、B超、FNAB对术前诊断桥本病合并甲状腺癌有重要价值，手术应按甲状腺癌根治原则进行。

Objective To investigate the diagnosis and treatment of Hashimoto＇ s disease concomitant with thyroid carcinoma. Methods Clinical data of 74 cases of thyroid carcinoma occuring on the background of Hashimoto＇s disease were retrospectively analyzed. Results All cases were papillary carcinoma pathologically. The serum TGAb and McAb level elevated in 56 and 68 cases, respectively. While TPOAb level was all elevated. 45 cases underwent unilateral thyroidectomy and contralateral subtotal thyroidectomy, 1 case did bilateral near total thyroidectomy, 26 cases did unilateral thyroidectomy, and 2 cases with bilateral thyroidectomy. All cases underwent combined central region lymph nodes dissection （positive rate was 27% ,20/74）, 10 cases underwent modified lymph node resection. 69 cases were fallowed up ranging from 1 month to 7 years,with median length of 29 months. 4 cases were re-admitted for modified lymph nodes resection. Conclusion TGAb, McAb, FNAB and ultrasound is the main procedure for screening Hashimoto＇s disease accompanied with thyroid carcinoma preoperatively. Radical thyroidectomy is the therapy of choice.