慢性淋巴细胞性甲状腺炎合并甲状腺癌40例临床分析

Analysis of 40 cases of chronic lymphocytic thyroiditis combined with thyroid cancer

目的分析慢性淋巴细胞性甲状腺炎合并甲状腺癌患者的临床特征、治疗及预后。方法回顾性分析2002年10月-2011年4月大连医科大学附属第一医院普外科收治的40例慢性淋巴细胞性甲状腺炎合并甲状腺癌病例，患者均为女性。结果超声诊断或疑诊为慢性淋巴细胞性甲状腺炎2例；行CT检查11例，提示甲状腺腺瘤2例，甲状腺癌合并淋巴结转移1例，考虑慢性淋巴细胞性甲状腺炎3例，其余皆未明确诊断。40例患者均行手术治疗，39例病理类型为慢性淋巴细胞性甲状腺炎合并甲状腺乳头状癌，1例为慢性淋巴细胞性甲状腺炎合并甲状腺髓样癌。40例患者术后均口服左旋甲状腺钠片。随访36例，失访4例，复发1例，其余患者情况稳定。结论淋巴细胞性甲状腺炎合并甲状腺癌术前较准明确诊断，需要通过甲状腺相关抗体、影像学及术中、术后病理检查等手段综合应用；术中、术后病理诊断是确诊手段。其主要病理类型是甲状腺乳头状癌，其中微小乳头状癌占有较大比例，手术治疗是最主要的治疗方式。

Objective To analyse the treatment, clinical features and prognosis of chronic lymphocytic thyroiditis combined with thyroid cancer. Methods Retrospectively analysed 40 cases with chronic lymphocytic thyroiditis combined with thyroid cancer, admitted to the Department of General Surgery of the First Affiliated Hospital of Dalian Medical University from November 2002 to April 2011. All the 40 patients were female. Results Ultrasound diagnosis or suspected diagnosis of chronic lymphocytic thyroiditis was made in 2 patients. Eleven patients underwent CT examination, and 2 patients were found with thyroid adenoma, 1 patient found with thyroid cancer and lymph node metastasis, 3 patients with chronic lymphocytic thyroiditis. Forty patients underwent surgical treatment, pathological results of 39 patients showed chronic lymphocytic thyroiditis with thyroid papillary carcinoma, 1 patient was medullary thyroid carcinoma combined with chron- ic lymphocytic thyroiditis. Forty patients were administrated levothyroxine tablets. Thirty-six patients were followed up, 4 patients were lost, 1 relapsed, the others were in stable condition. Conclusions Preoperative diagnosis is difficult for chronic lymphocytic thyroiditis combined with thyroid cancer, which needs through the thyroid antibody tests, imaging examinations and intraoperative, postoperative pathologic examination and other means of comprehensive application. The method of definitive diagnosis for CLT combined with TC is intraoperative, postoperative pathologic diagnosis. The main pathological type is papillary thyroid carcinoma, which small papillary carcinoma occupies a large proportion. Surgery is the main treatment for CLT combined with TC.