桥本甲状腺炎的外科诊治探讨

Experience with diagnosis and surgical treatment of Hashimoto's Disease

目的探讨桥本甲状腺炎的诊断和外科治疗时机及方法。方法回顾分析2003～2010年本科手术治疗的桥本甲状腺炎93例临床资料,总结分析本病的诊断程序、外科治疗适应征、手术方法及治疗效果。结果术后病理检查结果显示,桥本甲状腺炎34例,桥本甲状腺炎合并结节性甲状腺肿55例,合并甲状腺乳头状癌4例,合并甲亢2例。所有患者无近期并发症发生。随访72例,随访时间5月～7年,均无肿瘤复发,但有7例出现比较明显的甲状腺功能减退。结论对有恶性病变可能及甲状腺重度肿大而产生压迫症状、药物治疗无效的桥本甲状腺炎病人,应积极手术治疗。术中根据冰冻病理切片结果决定手术方式,应尽量保留足够的甲状腺组织。

Objective To summarize the clinical experience with the diagnosis and the surgical treatment of Hashinoto＇s disease （HD） based on our own data. Methods A retrospective study was carried out among 93 cases with HD, treated in our Hospital from 2003 to 2010. Careful analysis was made on their clinical data to explore diagnostic program and operative therapy indications, operating procedures and therapeutic results by surgical treatment for this kind of lesion. Results The postoperative pathological results verified that 34 cases were hashimoto thyroditis, 55 were hashimoto thyroditis complicated with nodular goiter, 4 were hashimoto thyroditis complicated with thyroid papillary carcinoma, and 2 were hashimoto thyroditis complicated with hyperthyreosis. No complication was occurred during the latest following up period. Among them, 72 cases were followed up from 5 months to 7 years, with no neoplasm recurred during this period except 7 cases with hypothyroidism fotmd. Conclusions HD cases complicated with thyroid nodules should be treated by surgery actively, especially for those nodules likely to be malignant, those with thyromegaly easily to induce compression on trachea, those with pain locally and those being refractory by pharmacotherapy. Intra-operative pathohistological assay by frozen section should give correct guide to the surgical modality. Enough thyroid tissue should be remained in situ as more as possible during operation in order to avoid postoperative hypothyroidism from developing.