桥本甲状腺炎合并甲状腺乳头状癌的临床特点及外科治疗

Thyroid papillary carcinoma in Hashimoto thyroiditis： clinicopathological features and surgical treatment

目的研究桥本甲状腺炎（HT）合并甲状腺乳头状癌（PTC）患者的临床特征，并探讨外科治疗方案。方法回顾性分析2009年1月至2010年12月问收治的首次手术的PTC患者资料128例，其中30例为HT合并PTC。结果女性HT合并PTC发病率为男性的6．5倍。HT合并FI＇C中央组淋巴结转移率（46．7％）略高于单纯PTC者（39．4％）。HT合并微小PTC的中央组淋巴结转移率（45．5％）明显高于单纯微小PTC者（16．7％）。直径〉1em的单纯PTC中央组淋巴结转移率（47．2％）明显高于单纯微小PTC者（16．7％）。而多灶PTC的中央组淋巴结转移率（73．3％）明显高于单灶癌者（36％）；HT合并多灶PTC的中央组淋巴结转移率（100％）明显高于单纯多灶PTC者（69．2％）。结论HT合并PTC多见于中年女性，易早期发生中央组淋巴结转移。全甲状腺切除并中央组淋巴结清扫是必要的治疗方法。

Objective To investigate the clinicopathological features and surgical treatment for Hashimoto thyroiditis （HT） concomitant with thyroid papillary carcinoma （ FFC ）. Methods The clinical data in 128 cases of PTC including 30 cases of HT concomitant with PTC treated surgically and diagnosis confirmed pathologically from Jan 2009 to Dec 2010 were retrospectively analyzed. Results The incidence of Hashimoto thyroiditis concomitant with thyroid papillary carcinoma was 6. 5 times higher among women than men. Rates of central lymph node metastasis in PTC concomitant with HT and PTC without HT were 46.7% and 39.4% , respectively. Rates of central lymph node metastasis in micro-PTC concomitant with HT and micro-PTC without HT were 45.5% and 16.7%. Rates of central lymph node metastasis in PTC 〉 1 cm were 47. 2%. Rates of central lymph node metastasis in multiple PTC concomitant with HT and multiple PTC without HT were 100% and 69. 2%. Conclusions Coexistent HT with PTC is common in middle-aged women. Central lymph node metastasis of PTC concomitant with HT is frequently involved irrespective of tumor size. Total thyroidectomy combined with central lymph node dissection is a safe and necessary management for HT concomitant with PTC.