结节性甲状腺肿与甲状腺癌并存的诊断与治疗(附68例临床报告)

Diagnosis and treatment of nodular goiter associated with thyroid cancer (a report of 68 cases)

目的 探讨结节性甲状腺肿与甲状腺癌并存的临床特点和诊治原则 ,进一步提高对该病诊断和治疗的认识。方法 回顾性分析 6 8例结节性甲状腺肿与甲状腺癌并存的临床资料。结果 本组病史平均 2 6 .6年 ;平均年龄 44.4岁 ;术前诊断率为 2 6 .4% ;伴发甲亢率为 5 .7% ;微小癌占 11.8% :以乳头状癌为主要病理类型。结论 病史长及年龄偏大的结节性甲状腺肿患者应想到合并甲状腺癌的可能性 ,此时结节性甲状腺肿的手术适应证应适当放宽 ;本病术前诊断率低 ,应重视术中对可疑结节的探查 ;并非一定行甲状腺癌根治术 ,根据术中冰冻结果采用相应术式。

Objective To study the clincal features and principal of diagnosis and treatment of nodular goiter associated with thyroid cancer,and to improve the ability to understand the disease.Methods The clinical data of 68 patients with nodular goiter associated with thyroid cancer were analysed retrospectively.Results The average time of disease history was 26.6 years.The average age was 44.4 years.The rate of diagnosis before operation was 26.4%.The rate of the disease with hyperthyroidism was 5.7%.The rate of microcarcinoma was 11.8%.The majority of the pathology was pipallary adenocarcinoma.Conclusion The logner course and the older age the patients with nodular goiter are,the more possibility the thyroid cancer happens,and then we should give these patients more operation chances.It is very important for us to distinguish the nodes in the operation because of the low diagnostic rate before operation.The choice of surgery for disease relies on the intraoperative frozen setions,and the radical dissection is not the only operation pattern.