原发性甲状腺功能亢进症合并甲状腺癌的诊断与治疗:附31例报告

Diagnosis and treatment of primary hyperthyroidism with concomitant thyroid cancer: a report of 31 cases

目的:探讨甲状腺功能亢进症(甲亢)合并甲状腺癌(甲癌)的临床病理特点。方法:回顾性分析吉林大学第一医院甲状腺外科2010年1月—2013年8月收治的甲亢合并甲癌患者临床资料,并结合文献比较。结果:手术治疗甲亢患者85例,其中31例(36.5%)合并甲癌。术前结合临床表现和颈部超声结果甲亢合并甲癌确诊率80.6%(25/31)。31例患者待甲亢症状得到控制、甲状腺功能经检查恢复正常后行手术治疗,并根据具体情况选择术式,术后均顺利出院,未发生永久性医源性喉返神经损伤及甲状旁腺功能减退。经术后病理证实,1例为髓样癌,30例为甲状腺乳头状癌;17例(54.8%)侵及被膜者,9例(29.1%)中央区淋巴结转移,各项病理特点与文献报道的单纯甲癌比较,差异均无统计学意义(均P>0.05)。结论:甲亢伴甲癌发病率有增高趋势,应强调颈部超声在该病早期诊断中的重要性,确诊后尽早行手术治疗并合理选择手术方式,预后较好。

Objective： To investigate the clinicopathologic characteristics of primary hyperthyroidism with concomitant thyroid cancer. Methods： The clinical data of patients with primary hyperthyroidism and concomitant thyroid cancer treated in Department of Thyroid Surgery in the First Hospital of Jilin University from January 2010 to August 2013 were retrospectively analyzed, and were also compared with data in the literature. Results： A total of 85 patients with primary hyperthyroidism underwent surgical treatment, and 31 cases had concomitant thyroid cancer. The preoperative diagnostic rate by clinical findings and neck ultrasound examination was 80.6% （25/31）. After control of the symptoms of hyperthyroidism and thyroid function recovery was assured by examinations, all the 31 patients underwent surgical treatment by different procedures according to the patient’s specific condition, and all of them were successfully discharged from the hospital after surgery. No iatrogenic permanent recurrent laryngeal nerve injury or hypoparathyroidism occurred. The postoperative pathology showed that one case was medullary carcinoma and all the other 30 cases were papillary thyroid carcinoma; 17 cases （54.8%） had capsular invasion, and 9 cases （29.10%） had lymph node metastasis in central compartment, but there was no statistical difference in any pathological parameter compared with that of thyroid cancer alone, which was reported in the literature. Conclusion： The incidence of primary hyperthyroidism with concomitant thyroid cancer shows an increasing trend, and the importance of neck ultrasound examination should be emphasized in early diagnosis of this condition. Timely surgical treatment with an appropriate procedure after diagnosis may offer favorable outcomes.