结节性甲状腺肿合并甲状腺癌20例临床探析

目的探讨结节性甲状腺肿合并甲状腺癌的临床特征和诊断治疗方法。方法选取2002年1月—2012年1月我院收治的结节性甲状腺肿合并甲状腺癌患者20例进行回顾性分析,观察结节性甲状腺肿合并甲状腺癌性别和年龄差异、临床诊断及治疗效果。结果 20例合并甲状腺癌患者占2 405例结节性甲状腺肿患者的0.83%;男女比例为∶12.33;60岁以上患者13例,占65.0%,60岁以下患者7例,占35.0%;术前、术中诊断甲状腺癌患者6例,占30.0%,术后诊断14例,占70.0%。20例患者经过手术治疗均生存,其中2例因甲状腺癌淋巴结转移再次进行手术治疗。结论结节性甲状腺肿与甲状腺癌有着密切关系,不同性别、不同年龄结节性甲状腺肿合并甲状腺癌发病率不同;冷冻切片快速病理学检查是诊断甲状腺癌的关键,在手术治疗时要根据患者的病情采取不同的方案。     

260例甲状腺疾病外科治疗体会

我院自1998年1月至2005年6月收治的各种甲状腺疾病260例,现报告如下. 1 资料与方法 1.1 临床资料本组260例,男44例,女216例,男女比例1∶4.9.年龄13～68岁.原发性甲状腺机能亢进症(甲亢)25例,继发性甲亢11例,结节性甲状腺肿131例,弥漫性甲状腺肿9例,甲状腺瘤65例,甲状腺癌19例(其中乳头状癌12例,滤泡状癌4例,髓样癌1例,混合癌2例).甲状腺二次手术18例:继发性甲亢2例,结节性甲状腺肿6例,甲状腺瘤2例,甲状腺癌8例,良性病变行患叶、峡部切除加对侧叶部分切除,恶性病变根据其临床分期和TNM分期决定治疗方案及手术方式.     

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)

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 68例结节性甲状腺肿与甲状腺癌并存的临床资料。结果 :该组病史平均 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 1 1 .8% ;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 ;该病术前诊断率低 ,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     

慢性淋巴细胞性甲状腺炎的诊断和治疗(附49例报告)

目的 :探讨慢性淋巴细胞性甲状腺炎 (CLT)的诊断 ,以及CLT合并其它甲状腺疾病的治疗方案选择。方法 :回顾性分析该院 1988～ 2 0 0 1年收治的 4 9例CLT的临床资料。结果 :术前诊断 11例 ,诊断率为 2 2 .4 %(11/ 4 9) ,其中经细针穿刺细胞学检查 (FNAC)诊断 10例 ,均予以甲状腺素片治疗 ,疗效满意。其余 38例分别误诊为其它甲状腺疾病而施行手术 ,其中合并甲亢 5例 ,合并结节性甲状腺肿 5例 ,合并甲状腺腺瘤 4例 ,合并甲状腺癌 3例 ;手术组中随访 2 7例 (71.1% ) ,6例发生甲低。结论 :全面的血清免疫学检查 ,结合FNAC检查可提高CLT的诊断率。该病以非手术冶疗为主 ,对合并其它病变者 ,应根据病理类型选择合理的治疗方案。     

结节性甲状腺肿合并甲状腺癌86例的手术治疗体会

目的 探讨结节性甲状腺肿合并甲状腺癌的临床特点及诊治原则,以提高该病的诊断和治疗水平.方法 回顾性分析86例结节性甲状腺肿合并甲状腺癌的临床资料.结果 手术治疗结节性甲状腺肿病人4 313例(次),其中86例合并甲状腺癌,占1.99%.行患侧甲状腺腺叶全切除+峡部切除+对侧次全切除+功能性颈部淋巴结清扫术,术后长期服用...     

性激素受体与甲状腺疾病的相关性

目的　探讨甲状腺肿瘤与雌、孕激素受体 (ER,PR)的相关性 .方法　采用酶联亲合组化法对手术切除的甲状腺标本 10 0例进行 ER及 PR检测 ,其中甲状腺癌 35例 ,甲状腺腺瘤 19例 ,结节性甲状腺肿 2 2例 ,正常甲状腺组织 2 4例 .结果　 ER及 PR的阳性率分别为 :甲状腺癌 49%和71% ;甲状腺腺瘤 37%和 42 % ;结节性甲状腺肿 18%和2 2 % ;正常甲状腺组织 4%和 8% .甲状腺癌和腺瘤组织中ER及 PR的阳性率 ,均明显高于甲状腺正常组织 (P<0 .0 1～0 .0 5 ) .年龄 <40岁组的甲状腺癌 ER阳性率 ,明显高于 >40岁组 (P<0 .0 5 ) .女性甲状腺癌 PR的阳性率明显高于男性(P<0 .0 5 ) .结论　甲状腺良、恶性病变及正常组织中均可检测到 ER及 PR,以甲状腺癌组织中含量最高 ,甲状腺腺瘤次之 .女性激素很可能是诱发甲状腺癌的重要因素 ,分化型甲状腺癌可能是女性激素依赖性肿瘤 ,ER及 PR的检验有助于甲状腺癌的早期诊断和鉴别诊断     

超声检查联合CT诊断结节性甲状腺肿合并甲状腺癌的价值分析

目的探究超声检查联合CT诊断结节性甲状腺肿合并甲状腺癌的价值。方法回顾性分析2019年2月至2020年12月平顶山市平煤总医院收治的疑似甲状腺癌患者110例。所有患者均进行超声检查及CT诊断,并以病理学检查结果作为金标准。比较两种检查方式在结节性甲状腺肿合并甲状腺癌中的检出结果、两种方式单项及联合检查与病理学检查的结果、两种检查方式及单项联合检查的诊断效能。结果病理结果显示,110例疑似患者中有80例确诊为结节性甲状腺肿合并甲状腺癌,其中乳头状癌58例,滤泡癌12例,髓样癌4例,未分化癌6例。CT诊断在乳头状癌的诊断检出率高于超声检查(P<0.05)。两种方式对滤泡癌、髓样癌、未分化癌的检出率比较,差异无统计学意义(P>0.05)。110例疑似患者经病理学检查后,确诊为阳性80例,阴性30例。经超声检查为阳性62例,阴性48例,其中仅有53例为结节性甲状腺肿合并甲状腺癌患者;CT检查为阳性74例,阴性36例,其中仅有62例为结节性甲状腺肿合并甲状腺癌患者;联合检查为阳性78例,阴性32例,其中仅有75例为结节性甲状腺肿合并甲状腺癌患者。联合检查的敏感性、特异性、准确性、阳性预测值与阴性预测值均高于超声检查与CT诊断的单项检查(P<0.05)。结论结节性甲状腺肿合并甲状腺癌行超声联合CT检查的诊断效能较单项检查更佳,具有较高的诊断价值。     

甲状腺功能亢进症并发甲状腺癌10例的临床分析

近几年来 ,甲状腺功能亢进症及甲状腺癌并存的文献报道增多 ,并存率为 0 76 %～ 8 7%。但目前就这两种疾病的关系、诊断与治疗等方面尚有不同看法。我院于 1994～ 2 0 0 2年共手术治疗 30 0例甲亢患者 ,经病理学诊断证实并发甲状腺癌患者 10例(3%) ,现报告如下。1　临床资料1 1一般资料　本组甲亢患者 30 0例 ,并发甲状腺癌10例 ,均经手术后病理学检查确诊。其中男 2例 ,女8例 .年龄 2 6～ 5 6岁 ,平均 38 6岁。 10例均有甲状腺肿大及甲状腺机能亢进症状。各项检查 :术前血清静总T3 、T4 、FT3 、FT4 测定均明显增高。促甲状腺激素 …     

甲状腺结节335例超声诊断回顾

本文通过对 335例甲状腺结节手术患者的超声声像图的回顾 ,找出偏差 ,以期提高超声诊断准确性。1　临床资料研究对象为我院 1 998年 1月～ 2 0 0 0年 6月期间的手术病例 ,术前经超声检查 ,术后经病理证实。其中男 82例 ,女 2 5 3例 ,男女比例 :1∶5 .1 2。年龄 1 7～ 78岁 ,平均年龄 47岁。仪器采用西门子 S2 -4 5 0及东芝 SSA-2 40超声诊断仪。频率 7.5 MHz,加 (或不加 )水囊 ,常规探测甲状腺。2　结　果335例中甲状腺腺病的诊断符合率为85 % ,甲状腺癌诊断符合率为 33% ,结节性甲状腺肿诊断符合率 5 1 %。3　讨　论结节性甲状腺肿的符…     

结节性甲状腺肿与甲状腺腺瘤692例病理诊断分析

在临床病理工作中甲状腺疾病常见 ,其病因复杂 ,存在多病变并存现象 ,且密切相关、相互影响 ,合理准确的病理诊断是指导临床治疗和随访的重要依据。现将本科室 1996年 1月～ 2 0 0 0年 12月外检中 6 92例结节性甲状腺肿与甲状腺腺瘤进行回顾性复检 ,以进一步提高对这两种疾病诊断和鉴别诊断水平。1　材料与方法1.1　材料　本组 6 92例结节性甲状腺肿与甲状腺腺瘤选自病理检查档案材料。其中男性 10 7例 (15 .5 % ) ,女性 5 85例(84 .5 % ) ,男女之比为 1∶ 5 .5 ,年龄 38.75± 14 .16岁 (11～79岁 ) ,高发年龄 2 2～ 5 2岁 ,共 4 35例 ,占总…     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.