原发性甲状腺功能亢进症合并甲状腺微小癌42例临床分析

Clinical analysis of 42 primary hyperthyroidism patients complicated with thyroid microcarcinoma

目的:分析原发性甲状腺功能亢进症(简称甲亢)合并甲状腺微小癌的临床特征,指导临床诊疗。方法:回顾性分析湖北医药学院附属人民医院2013年1月至2019年3月行手术治疗的甲亢合并甲状腺微小癌患者42例(研究组)和无合并甲亢的甲状腺微小癌患者410例(对照组)的临床资料,比较两组流行病学特征、临床诊疗、临床分期、B超特点、甲状腺功能与抗体、病理资料和预后。结果:研究组、对照组中B超发现微小钙化的比例分别为61.9%(26/42)、33.4%(137/410)(χ 2=13.411、 P<0.05),发现多灶结节的比例分别为47.62%(20/42)、69.02%(283/410)(χ 2=7.899, P<0.05);研究组、对照组术中冰冻检查甲状腺微小癌诊断率分别为61.9%(26/42)、66.1%(271/410)(χ 2=4.460, P<0.05),淋巴结转移率分别为9.5%(4/42)、26.8%(110/410)(χ 2=6.049, P<0.05)。该组病例中位随访时间37个月,研究组术后均无甲状腺癌复发,有2例术后甲亢复发,对照组3例甲状腺微小癌复发,均二次手术切除。两组随访均无死亡病例。 结论:甲亢合并结节时应警惕甲状腺癌的发生,但甲亢合并微小癌预后较好,术式倾向于双侧叶全切术,可以预防甲亢复发,术中可能不需预防性Ⅵ区淋巴结清扫,以降低甲状旁腺和喉返神经损伤的概率。

Objective To analyze the clinical data of primary hyperthyroidism patients complicated with thyroid microcarcinoma,and to guide clinical diagnosis and treatment.Methods From January 2013 to March 2019,the clinical data of 42 cases of hyperthyroidism with thyroid microcarcinoma(study group)and 410 cases of thyroid microcarcinoma without hyperthyroidism(control group)who underwent surgical treatment in the People's Hospital Affiliated to Hubei University of Medicine were retrospectively analyzed.The epidemiological characteristics,clinical diagnosis and treatment,clinical stage,B-ultrasound characteristics,thyroid function and antibody,pathological data and prognosis of the two groups were compared.Results In study group and control group,the proportion of microcalcification detected by B-ultrasonography was 61.9%(26/42)and 33.4%(137/410),respectively,the difference was statistically significant between the two groups(χ2=13.411,P<0.05).In study group and control group,47.62%(20/42)and 69.02%(283/410)of multifocal nodules were detected by B-ultrasound,the difference was statistically significant between the two groups(χ2=7.899,P<0.05).The diagnostic rates of intraoperative frozen-section examination of the study group and the control group were 61.9%(26/42)and 66.1%(271/410),respectively,the difference was statistically significant between the two groups(χ2=4.460,P<0.05).The lymph node metastasis rates of the study group and the control group were 9.5%(4/42)and 26.8%(110/410),respectively,the difference was statistically significant between the two groups(χ2=6.049,P<0.05).The middle follow-up period was 37 months(1 month to 74 months).There was no recurrence of thyroid cancer in the study group,2 cases with recurrence of hyperthyroidism after operation,and 3 cases with recurrence in the control group,with secondary surgical resection.There were no deaths in the two groups during follow-up.Conclusion Thyroid cancer should be paid attention to when hyperthyroidism combined with nodules,but the prognosis of hyperthyroidism with microcarcinoma is better.The operation method tends to be bilateral lobectomy,which can prevent the recurrence of hyperthyroidism.In order to reduce the chance of parathyroid gland and recurrent laryngeal nerve injury,there may be no need of preventive lymph node dissection in area VI.