外科手术在甲状腺淋巴瘤处理中的作用

The role of surgery in the management of thyroid lymphoma

目的 评价外科手术在甲状腺淋巴瘤处理中的作用。方法 14 例甲状腺淋巴瘤患者中,行细针穿刺1 例,切取活检4 例,甲状腺腺叶切除8 例,全甲状腺切除1 例。单纯放疗4 例,单纯化疗2 例,放疗加化疗7 例,术后拒绝放化疗1 例。结果 1 例穿刺细胞学无分类,13 例均为非霍奇金淋巴瘤。B 细胞来源11 例,T 细胞来源2 例。随诊期间(5 ～112 个月)7 例无瘤生存,3 例死于肿瘤,1例死于并发症,2 例死于其他疾病,1 例失随。大范围的手术切除对患者的生存无明显提高。结论 外科手术对甲状腺淋巴瘤的作用有限,对肿瘤局限在甲状腺内的患者,行手术切除结合放疗和( 或) 化疗对生存有益,否则仅起到组织诊断的作用。

Objective To evaluate the role of surgery in the management of thyroid lymphoma.Methods A retrospective analysis was performed of 14 patients with thyroid lymphoma treated at the Cancer Hospital, Peking Union Medical College, Chinese Academy Medical Science from 1964 to March 1998. There were 5 males and 9 females, with a median age of 54 years (range 15～75). There were 4 cases in stage IEA, 9 in stage IIEA, 1 in stage ⅡEB. Fine needle aspiration biopsy was performed in 1 case, excision biopsy in 4, thyroid lobectomy in 8, and total thyroidectiomy in 1. Radiotherapy was used alone in 4 patients, chemotherapy alone in 2, radiotherapy combined with chemotherapy in 7, no postoperative treatment in 1.Results All but 1 patients were histopathologically diagnosed as non Hodgkin′s lymphoma. It was of B cell origin in 11 cases, T cell origin in 2. Seven patients were alive without evidence of recurrent disease at follow up, ranging from 5 to 112 months. Three patients died of lymphoma, 1 died of treatment complication, 2 died of other diseases, and 1 lost from follow up. The major surgical resection did not appreciably affect survival.Conclusion Radiotherapy or chemotherapy, alone or in combination, is the treatment of choice for thyroid lymphoma. Surgical resection combined with radiotherapy or chemotherapy may be beneficial to survival in patients with intrathyroid lymphoma. It is otherwise limited to make a tissue diagnosis.