桥本病合并甲状腺微小癌的外科临床策略

Surgical methods of Hashimoto's disease complicated with thyroid microcarcinoma

目的探讨桥本病合并甲状腺微小癌的外科临床处理对策。方法回顾性分析1995年1月～2011年9月外科手术治疗的25例桥本病与甲状腺微小癌并存患者的临床资料。结果桥本病与甲状腺微小癌并存发生率为9.8%(25/256),其中乳头状癌19例,滤泡状癌6例,术中冰冻切片确诊24例(96.0%),1例(4.0%)术后石蜡切片确诊。1例术后确诊患者未行二次手术。根据患者的术前检查结合术中冰冻确定手术方式,包括甲状腺患侧腺叶及峡部+对侧腺叶次全切除、双侧甲状腺叶次全切除,除1例术后确诊患者外所有患者均同期行中央区淋巴结清扫。随访6个月～17年,均存活至今。结论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。术前触诊、彩超检查,细针针吸活检、及冰冻组织切片对提高桥本病合并甲状腺微小癌的诊断率非常重要。手术是最有效的治疗手段。

[ Objective ] To investigate the surgical methods of Hashimoto＇s disease complicated with thyroid microcareinoma. [ Methods ] A retrospective analysis was performed in 25 cases of Hashimoto＇s disease complicated with thyroid microcareinoma treated from January 1995 to September 2011. [ Results ] Among the 25 of all 256 patients （9.8%）, 19 cases had papillary thyroid carcinoma, 6 cases had follicular thyroid carcinoma, there were 24 cases confirmed by the frozen section examination, accounting for 96.0%, and another 1 case was confirmed after operation, accounting for 4.0%. One patient did not undergo remedial surgery. Bilateral total resection or total resection of the affected lobe plus isthmus and contralateral lobeetomy were made on basis of both pre-surgery data and insurgery frozen section histological examination .Central region lymph nodes were removed in 24 cases. Follow ed up for 6 months to 17 years, all cases have been all alive by now. [Conclusion] Hashimoto＇s disease is preoperative diagnosed poorly, coexistence with micro type should be taken more caution. It is meaningful for confirming microcarcinoma by preoperative palpation, color-Doppler ultrasound,the effects of fine needle aspiration and the frozen- section examination .Surgery procedure is the most effective.