结节性甲状腺肿合并甲状腺癌的临床特征分析

Clinical characteristic analysis of patients with nodular goiter combined with thyroid cancer

目的探讨结节性甲状腺肿合并甲状腺癌的临床特点和诊治措施,为临床治疗提供理论依据。方法收集并分析286例结节性甲状腺肿合并甲状腺癌患者的临床资料。结果 CT和超声检查的结果显示,结节性甲状腺肿合并单发甲状腺癌患者30例(10.5%),合并多发病灶的患者256例(89.5%),双侧病灶的患者135例(47.2%)。与结节性甲状腺肿组织特征相比,甲状腺癌结节边缘中断征(32%)、边缘不清(70%)和细颗粒状钙化(84%)的比例显著增高,差异均有统计学意义(均P<0.05)。乳头状癌202例,滤泡状癌50例,未分化癌32例,髓样癌2例,患者均无远隔器官的转移,其中N0期202例,N1期84例,T1期196例,T2期40例,T3期30例,T4期20例。所有患者均接受手术治疗,无严重并发症和死亡。结论在临床治疗中要高度警惕单侧孤立结节或存在钙化的甲状腺结节,应结合病理检查给予积极的手术治疗,以免结节恶化。

Objective To analyze the clinical characteristics of patients with nodular goiter combined with thyroid cancer and provide theoretical basis for effective treatment. Methods Clinical characteristics of 286 patients with nodular goiter combined with thyroid cancer were analyzed. Results The number of nodular goiter combined with solitary thyroid nodules, merge muhiple lesions and bilateral lesions were 30 （ 10. 5% ）, 256 （89. 5% ） and 135 （47.2%）, respectively, using CT and B-ultrasonic examination. The rates of thyroid nodules edge interrupt levy （32%）, the edge unclear （70%） and fine granular calcifications （84%） was significantly higher than that nodular goiter （ x2 = 25.24, 17.34, 4. 87, P 〈 0. 05）. There were 202 cases papillary carcinoma, 50 cases follicular carcinoma, 32 cases undifferentiated carcinoma and 2 cases medullary carcinoma. No distant organ metastasis was observed. The cases of NO stage, N1 stage, T1 stage, T2 stage, I3 stage, T4 stage were 202, 84, 196, 40, 30, 20, respectively. All patients underwent surgical treatment, no serious complications and deaths were observed. Conclusions The unilateral solitary nodule or calcified thyroid nodules symptoms should be highly vigilance in clinical treatment. Aggressive surgical treatment coupled with pathological examination should be given to avoid nodules worse.