桥本病合并甲状腺癌的临床分析

Clinical analysis of Hashimoto's disease complicated with thyroid cancer

目的探讨桥本病合并甲状腺癌的临床病理特点及手术治疗经验。方法回顾性分析本院1996年至2008年外科手术治疗的24例桥本病与甲状腺癌并存患者的临床病理特征以及手术方式的选择。结果桥本病与甲状腺癌并存发生率为12.8%(24/187),其中乳头状癌16例,滤泡状癌5例,混合性癌3例;微小癌7例,占29.2%;双侧甲状腺癌6例,占25%;中央区淋巴结转移13例,占54.2%。根据患者的术前检查结合术中冰冻确定手术方式,包括甲状腺腺叶及峡叶切除、甲状腺次全切除和甲状腺全切除,所有患者均同期行中央区淋巴结清扫。结论桥本病与甲状腺癌并存发生率较高,桥本病并发甲状腺癌术前确诊率低,尤其应警惕合并微小癌的可能。病史、细针针吸活检、彩色超声等综合分析有利于术前诊断,手术是其最有效的治疗方法。

Objective To investigate pathological features and surgery treatments for thyroid carcinoma associated Hashimoto＇ s disease, Methods Clinical data and pathology feature of 24 Hashimoto＇s disease patients were reviewed. All of 24 patients had concurrent thyroid carcinoma and accepted surgical treatments at Sichuan Cancer Center from 1996 to 2008. Results Among the 24 of all 187 patients （ 12.8% ）, 16 cases had papillary thyroid carcinoma, 5 cases had follicular thyroid carcinoma, 3 cases had mixed papillary-follicular carcinoma. Seven cases （29.2%）suffered from micro thyroid carcinoma, six cases （25%） had bilateral cancer, and 13 cases （54.2%） developed central region lymph node metastasis. Selection of thyroid lobectomy, subtotal or total parathyroidectomy were made on basis of both pre-surgery data and in-surgery frozen section histological exami nation. Central region lymph nodes were removed in all cases. Conclusions Hashimoto＇s disease is preoperative diagnosed poorly, although has a high coexistence rate with thyroid carcinoma. Coexistence with micro type should be taken more caution. Comprehensive analysis with case history and the effects of fine needle aspiration and color Doppler ultrasonography have benefits on the preoperative diagnosis. Surgery procedure is the most effective.