甲状腺滤泡状癌误诊误治原因探讨(附42例分析)

Misdiagnosis and Mistherapy of Thyroid Follicular Cancer(A Analysis of 42 Cases)

目的 提高对甲状腺滤泡状癌临床特性的认识 ,减少误诊误治。方法 回顾性分析近 10年来收治的 42例甲状腺滤泡状癌病例资料 ,对其诊断、治疗及辅助检查进行探讨。结果 42例均有病理证实为甲状腺滤泡状癌 ,其中合并有甲状腺乳头状癌 2例。术前诊断为甲状腺癌伴颈淋巴结转移 14例 ,甲状腺癌 6例 ,甲状腺肿物 12例 ,甲状腺瘤 5例 ,甲状腺囊肿 2例 ,甲状腺滤泡状癌局部剜除术后 2例 ,甲状腺癌肺转移 1例。 19例行甲状腺癌联合根治术 ,15例行 1侧腺叶加峡部切除术 ,5例行甲状腺近全切除术 ,2例行甲状腺肿瘤剜除术 ,1例行全甲状腺切除加同位素治疗。结论 术前诊断甲状腺滤泡状癌比较困难 ,易误诊为甲状腺瘤或囊肿。为减少误诊误治 。

Objective To identify clearly the clinic characteristics of thyroid follicular cancer. Methods A retrospective review was conducted for over ten years. During this time, there were 42 patients whose diagnosis?treatment and all kinds of examinations were analysed respectively. Results 42 cases were diagnosed as pathologically thyroid follicular cancer, of which there were 2 cases of thyroid follicular cancers associated with thyroid papillary carcinomas. Before operation, there were 14 cases of thyroid adeno-carcinomas associated with lymph node metastasis, 6 thyroid adeno-carcinomas, 12 thyroid tumors, 5 thyroid adenomas, 2 thyroid cysts, 1 thyroid adeno-carcinoma associated with lung metastasis, 2 postoperative thyroid follicular cancers that were treated in other hospital. 19 cases were performed combined radical operations 15 unilateral lobectomy plus isthmus resection, 5 subtotal thyroidectomy, 2 tumors enucleated and 1 total thyroidectomy plus radioisotope treatment. Conclusions Thyroid follicular cancer is often to be diagnosed as a thyroid adenoma or a thyroid cyst, because its preoperative diagnosis is very difficult. To decrease misdiagnosis of thyroid follicular cancer, it is important for us to emphasize aspiration biopsy and frozen section examination.