自主功能性甲状腺结节104例临床分析

Clinical analysis on 104 patients with autonomously functioning thyroid nodule

目的提高对自主功能性甲状腺结节（ＡＦＴＮ）的诊断与治疗水平。方法１０４例ＡＦＴＮ中同位素结合促甲状腺激素刺激扫描诊断１６例，结合甲状腺激素抑制扫描诊断２０例，结合手术前后扫描诊断６８例。全部病例均行手术治疗，手术方式有单纯结节摘除，一叶部分或全切除，双叶次全切除及癌根治术。结果１０４例ＡＦＴＮ中，同位素扫描为“热结节”者９４例，“温结节”者１０例，继发甲状腺机能亢进２５例（２４％），７６例来自地方性甲状腺肿流行区。病理类型：结节性甲状腺肿７６例（７３１％），甲状腺腺瘤２６例（２５０％），甲状腺癌２例（１９％）。对２６例ＡＦＴＮ患者进行术后３～２２年随访，未发现结节复发及甲低等并发症。结论碘缺乏可能在ＡＦＴＮ形成中起重要作用；同位素扫描是诊断ＡＦＴＮ的主要手段；ＡＦＴＮ患者一旦确诊应及时治疗，手术是较好的治疗方法。

Objective To improve the diagnosis and treatment of patients with autonomously functioning thyroid nodule (AFTN).Methods The diagnosis of 104 cases was established by isotope scan combining inhibition test, stimulation test and operation. All cases underwent surgery.Results Of the 104 cases, 94 hot nodules and 10 warm nodules were found by isotope scan; 25 cases were diagnosed as AFTN with hyperthyroidism; 76 patients were from iodine deficiency areas. The pathologic types were nodules goiter in 76 cases (73 1%),adenoma in 26 (25%) and carcinoma in 2 (1 9%). After operation , 26 cases were followed up from 3 to 22 years, complications such as nodular goiter recurrence and hypothyroidism were not found.Conclusions Iodine deficiency played an important role in the occurence of AFTN; Isotope scan is a major method for the diagnosis of AFTN;Patients should be treated as soon as they were diagnosed,and operation was the treatment of choice.