甲状腺癌中央区淋巴结清扫术后乳糜漏的原因及防治

目的 探讨甲状腺癌中央区淋巴结清扫术后发生乳糜漏的原因和治疗方法。方法 选取烟台毓璜顶医院甲状腺外科2016年8月～2019年12月2578例甲状腺癌中央区淋巴结清扫术病例,观察术后引流液的量、性状的变化及发生变化的时间,根据诊断标准判断患者乳糜漏的发生。结果 其中23例患者术后出现了中央区乳糜漏,发生率为0.9%(23/2578)。发生中央区乳糜漏后,给予禁饮食、持续强负压吸引、应用生长抑素,短期的治疗效果不佳者,辅以加压包扎、创腔注射高渗糖或泛影葡胺等痊愈,治疗时间最长38 d,无二次开放手术治疗的病例。结论 甲状腺癌淋巴结清扫术后中央区乳糜漏的发生率相对较低,术后1～2 d引流量异常增多或引流液性状改变时应警惕中央区乳糜漏的发生,及时采取相应的禁饮食、持续强负压吸引、应用生长抑素等措施,基本上均可保守治愈。     

女性分化型甲状腺癌患者超声特点及危险因素分析

目的 对甲状腺结节病理特征及与超声特点进行相关性分析,探讨女性分化型甲状腺癌超声特点及相关危险因素。方法 回顾性选取北京大学国际医院2014 年12 月～2018 年4 月因甲状腺结节行病理检查的287 例患者资料,分析不同性质结节的临床、病理特征及超声特点。结果 287 例患者（男81 例,女206 例）中,病理诊断恶性病变者144 例（50.17%）,甲状腺乳头状癌132 例,滤泡状癌9 例,髓样癌3 例。超声影像特点：低回声结节比例,恶性（69.44% ）高于良性（22.38%）（P＜0.05）;实性结节比例,恶性（83.33%）高于良性（17.48%）（P＜0.05）;结节内血流丰富程度比例,恶性（73.61%）高于良性（42.66%）（P＜0.05）;结节形态不规则比例,恶性（68.75%）高于良性（19.58%）;结节纵横比＞1 的比例,恶性（77.08%）高于良性（9.09%）（P＜0.05）。甲状腺球蛋白抗体（Thyroglobulin antibody,TgAb）阳性率恶性结节中高于良性结节。Logistic 回归模型结果显示,女性发生恶性病变的风险是男性6 倍（OR：6.549,95%CI：1.313～32.658,P＜0.05）。结节低回声（OR：0.034,95%CI：1.148～32.607,P＜0.05）及TgAb 阳性（OR：4.062,95%CI：1.021～16.160,P＜0.05）为女性分化型甲状腺癌危险因素。而结节低回声（OR：0.119,95%CI：0.006～2.495,P＞0.05）及TgAb 阳性（OR：0.097,95%CI：0.004～2.206,P＞0.05）与男性分化型甲状腺癌的发生无明显相关。结论 女性甲状腺结节恶变风险较男性更高。重点监测低回声结节及TgAb 水平有助于女性分化型甲状腺癌的诊断及评估。     

子宫内膜息肉摘除术后两种内膜准备方案临床结局的比较

目的：比较子宫内膜息肉摘除术后,应用促性腺激素释放激素激动剂降调节激素替代治疗（GnRH-a+HRT）和激素替代治疗（HRT）进行内膜准备的临床结局。方法：回顾性分析2018年7月至2019年7月在温州医科大学附属第二医院生殖中心子宫内膜息肉摘除术后3个月内行HRT或GnRH-a+HRT方案的患者,比较2组患者的基本情况,囊胚移植情况以及妊娠结局。结果：HRT组患者56例,取消移植1例;GnRH-a+HRT组患者53例,无周期取消。2组患者基本情况差异无统计学意义（P＞0.05）;2组不孕因素差异无统计学意义（P＞0.05）;2组间囊胚移植日子宫内膜情况、囊胚移植情况差异无统计学意义（P＞0.05）;2组间HCG阳性率、胚胎着床率、临床妊娠率、多胎妊娠率与早期流产率差异无统计学意义（P＞0.05）。结论：HRT方案与GnRH-a+HRT方案均能获得较好的妊娠结局。     

2型糖尿病患者生化指标与甲状腺功能指标分析

目的探讨2型糖尿病患者生化指标与甲状腺功能指标的变化,以及2糖尿病患者甲状腺疾病的患病情况。方法随机选取2014年1月至6月我院住院的2型糖尿病患者(T2DM)295例(2型糖尿病组),健康人员80例(对照组),检测其生化指标15项:丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总蛋白(TP)、白蛋白(ALB)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、葡萄糖(GLU)、肌酸激酶(CK)、总胆固醇(CH)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、钙(Ca)、磷(P)、糖化血红蛋白(Hb A1c),甲状腺功能指标5项:甲状腺素(T4)、三碘甲腺原氨酸(T3)、游离T4(FT4)、游离T3(FT3)、促甲状腺激素(TSH),并对2型糖尿病组结合临床资料进行分析。结果2型糖尿病组中生化类指标TP、ALB、GLU、CH、TG、Ca、P、HDL、LDL、Hb A1c及甲状腺功能指标T3、FT3与对照组相比均有统计学意义(P<0.05);2型糖尿病组中患有甲状腺结节的患者比例最高,为44.7%;将2型糖尿病患者分为甲状腺结节组,其它甲状腺疾病组,甲状腺正常组,将甲状腺结节组和甲状腺正常组进行比较,年龄差异具有统计学意义(P<0.01),甲状腺结节组为53±12岁,甲状腺正常组为46±13岁,性别无差异(P>0.05),糖尿病病程差异具有统计学意义(P<0.01),甲状腺结节组为9±6年,甲状腺正常组为7±6年,对两组代谢指标进行分析,FT3差异显著(P<0.05),甲状腺结节组为4.48±0.82pmol/L,甲状腺正常组为4.67±0.67pmol/L,其它指标差异均无统计学意义(P>0.05);将2型糖尿病患者按空腹血糖水平分为A、B、C三组,血糖越高,甲状腺结节的比例越高,但差异无统计学意义(P>0.05)。结论 2型糖尿病患者其T3、FT3和一系列生化指标会发生变化,监测这些指标有助于对2型糖尿病进行更为全面的评估,且2型糖尿病患者中,甲状腺结节发病比例较高,且与年龄和病程相关,对于年龄较大和病程较长的患者更要关注甲状腺的检查。     

Pyramidal lobe decreases endogenous TSH stimulation without impact on radio-iodine therapy outcome in patients with differentiated thyroid cancer

Objectives

The aim of the study was to assess the frequency of pyramidal lobe (PL) detected in iodine-131 (I-131) scans of thyroid bed in patients after thyroidectomy for differentiated thyroid cancer (DTC) and to investigate influence of PL on endogenous thyrotropin (TSH) stimulation as well as on the effects of the radio-iodine ablation in one-year follow-up.

Patients and methods

This study was designed as a retrospective analysis of 302 radio-iodine neck scans of patients thyroidectomized due to DTC. The study population was selected from patients with PL detected in thyroid bed scintigraphy. Patients without PL were included to the control group. The study and the control groups did not differ in age, sex of patients, histological type and stage of the DTC.

Results

Pyramidal lobes were found in 30.5% of all patients. Patients in the study group underwent repeat surgery more often than controls without PL. Preablative TSH level in patients with PL was statistically lower than in the control group, in contrast to free thyroid hormones, which were higher in patients with PL. Preablative and postablative TSH-stimulated thyroglobulin (Tg) and antibodies against thyroglobulin (TgAbs) were measured in both groups, and comparison did not reveal differences. Moreover, for the per-patient analysis, sites of uptake in whole body scintigraphy performed 1 year after radio-iodine remnant ablation (RRA) did not differ between the study and the control groups.

Conclusion

Pyramidal lobe decreases endogenous TSH stimulation without impact on radio-iodine therapy outcome in patients with DTC.     

Levothyroxine Dosage Is Associated with Stability of Thyroid-stimulating Hormone Values

Objective

In patients treated for hypothyroidism, the usual practice is to monitor thyroid-stimulating hormone values yearly once a therapeutic dosage of levothyroxine is determined. This study investigates whether there are any clinical predictors that could identify a subset of patients who might be monitored safely on a less frequent basis.

Methods

With the use of a retrospective study design, 715 patients treated for hypothyroidism who had a normal (ie, therapeutic) thyroid-stimulating hormone value in 2006 while taking levothyroxine were identified. All thyroid-stimulating hormone values were then obtained through December 31, 2012. By using a Cox proportional hazard model, gender, age, body mass index, history of chronic autoimmune thyroiditis, initial thyroid-stimulating hormone level, and levothyroxine dose were analyzed for time to first abnormal thyroid-stimulating hormone value.

Results

Age, gender, history of chronic autoimmune thyroiditis, and body mass index at the time of initial normal thyroid-stimulating hormone were not associated significantly with time to abnormal thyroid-stimulating hormone value. Levothyroxine dose >125 μg/day had an increased hazard ratio of 2.4 (95% confidence interval, 1.7-3.4; P < .0001) for time to first follow-up abnormal thyroid-stimulating hormone value, but dosages less than that did not increase the hazard ratio. One year after the initial normal thyroid-stimulating hormone value, 91.1% of patients taking ≤125 μg/day had a continued normal thyroid-stimulating hormone, whereas only 73.3% of patients taking >125 μg/day did. Transformed thyroid-stimulating hormone value (which represents a measure of how far the initial thyroid-stimulating hormone was from the midpoint of the normal range) also had an increased hazard ratio of 1.14 (95% confidence interval, 1.1-1.2; P < .0001) for time to first abnormal thyroid-stimulating hormone value.

Conclusions

For patients receiving ≤125 μg/day of levothyroxine, we propose that a testing interval up to 2 years may be acceptable if their thyroid-stimulating hormone is well within the normal range.     

复方丹参注射液辅助甲氨蝶呤治疗宫外孕的临床疗效分析

目的 探讨复方丹参注射液辅助甲氨蝶呤治疗宫外孕的临床疗效。方法 选取2015年3月-2017年3月在平煤神马医疗集团总医院诊治的宫外孕患者61例,根据随机数字表法将患者分为两组,对照组（30例）采用超声引导下甲氨蝶呤介入治疗,观察组（31例）在对照组的基础上给予复方丹参注射液。比较两组患者的临床疗效、临床症状恢复时间、激素水平及不良反应发生率。结果 观察组总有效率为93.55%,显著高于对照组的73.33%（P<0.05）;观察组患者的腹痛消失时间、1周后包块大小、人绒毛膜促性腺激素（β-HCG）恢复正常时间和阴道出血消失时间均显著小于对照组（P<0.05）。两组患者治疗后雌激素（E₂）、孕酮（P）和睾酮（T）水平均显著下降（P<0.05）,但组间比较均无统计学差异。两组总不良反应发生率无统计学差异,均经对症处理后好转。结论 复方丹参注射液辅助甲氨蝶呤介入治疗宫外孕临床效果显著,可快速解除临床症状,提高治疗有效率,且不影响患者的激素水平,不增加不良反应发生率,值得临床借鉴。     

培坤丸联合左炔诺孕酮治疗围绝经期功能失调性子宫出血的疗效观察

目的探讨培坤丸联合左炔诺孕酮治疗功能失调性子宫出血患者的安全性与有效性。方法选取2013年2月—2018年2月在自贡市妇幼保健院诊治的功能失调性子宫出血患者78例,根据用药差别分成对照组(39例)和治疗组(39例)。对照组患者口服左炔诺孕酮片,2片/次,2次/d,待阴道停止流血3 d后,药量改为1次/d,1片/次,维持治疗14 d,1个月经周期为1个疗程。治疗组患者在对照组基础上口服培坤丸,9g/次,2次/d。两组患者均连续治疗3个疗程。观察两组患者临床疗效,同时比较治疗前后两组患者血红蛋白水平、经期天数、WHOQOL-BREF评分及性激素水平。结果治疗后,对照组和治疗组临床有效率分别为76.92%和94.87%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者血红蛋白水平和WHOQOL-BREF评分均显著升高(P0.05),经期天数均显著减少(P0.05),且治疗组上述指标明显优于对照组(P0.05)。治疗后,两组患者雌二醇、卵泡刺激素和促黄体生成素均显著降低(P0.05),且治疗组雌二醇、卵泡刺激素和促黄体生成素水平明显低于对照组(P0.05)。结论培坤丸联合左炔诺孕酮治疗功能失调性子宫出血疗效显著,不良反应少,且能够显著提升排卵率,具有一定的临床推广应用价值。     

桂枝茯苓胶囊联合孕三烯酮治疗卵巢子宫内膜异位囊肿的临床研究

目的探讨桂枝茯苓胶囊联合孕三烯酮胶囊治疗卵巢子宫内膜异位囊肿的临床疗效。方法选取2017年4月—2018年9月在迁安燕山医院接受手术治疗的86例卵巢子宫内膜异位囊肿患者为研究对象,采用随机数字表法将86例患者分为对照组和治疗组,每组各43例。对照组患者在术后第1天口服孕三烯酮胶囊,1粒/次,第3天服用第2次,2次/周,之后在每周的相同时间内服药。治疗组患者在对照组治疗的基础上口服桂枝茯苓胶囊,3粒/次,3次/d。两组患者连续治疗6个月。观察两组的临床疗效,比较两组的卵巢基质动脉血流动力学、性激素水平、血清因子水平。结果治疗后,对照组和治疗组的总有效率分别为79.07%、95.35%,两组比较差异有统计学意义(P0.05)。治疗后,两组患者收缩期血流峰值速度(PSV)、搏动指数(PI)、动脉直径(D)值均较治疗前升高,阻力指数(RI)值较治疗前降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组卵巢基质动脉血流动力学指标明显优于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组患者的血清促黄体生成素(LH)、促卵泡刺激素(FSH)水平均较治疗前升高,雌二醇(E2)、孕酮(P)水平均较治疗前降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组患者性激素水平明显优于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组患者血清癌抗原125(CA125)、血清癌抗原199(CA199)、血管内皮生长因子(VEGF)水平均较治疗前显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗组患者血清因子水平明显低于对照组(P0.05)。结论桂枝茯苓胶囊联合孕三烯酮胶囊治疗卵巢子宫内膜异位囊肿具有较好的临床效果,可减轻临床症状,促进卵巢功能恢复,具有一定临床推广应用价值。     

The effect of vitamin D on thyroid autoimmunity in euthyroid men with autoimmune thyroiditis and testosterone deficiency

BackgroundAutoimmune (Hashimoto’s thyroiditis) is characterized by a strong female preponderance, which may suggest that sex hormones have an impact on thyroid autoimmunity. The aim of this study was to investigate whether testosterone determines vitamin D action on thyroid antibody titers and thyroid function tests in men with autoimmune thyroiditis and low testosterone levels.MethodsThe study included 36 men with testosterone deficiency, 17 of whom had been treated for at least 26 weeks with oral testosterone undecanoate (120 mg daily). Because of coexistent euthyroid Hashimoto’s thyroiditis, all participants were then treated with vitamin D (100 μg daily). Serum titers of thyroid peroxidase and thyroglobulin antibodies, serum levels of thyrotropin, free thyroid hormones, testosterone and 25-hydroxyvitamin D, as well as Jostel’s thyrotropin index, SPINA-GT and SPINA-GD were assessed before vitamin D treatment and 26 weeks later.ResultsWith the exception of testosterone levels, there were no significant differences between both study groups in serum hormone levels, antibody titers and thyroid function tests. All participants completed the study. In addition to increasing 25-hydroxyvitamin D levels, vitamin D increased SPINA-GT and reduced thyroid peroxidase and thyroglobulin antibody titers. In testosterone-treated men, vitamin D increased testosterone levels. Vitamin D did not affect serum levels of thyrotropin, free thyroid hormones, Jostel’s thyrotropin index and SPINA-GD. Treatment-induced changes in thyroid antibody titers and SPINA-GT were more pronounced in testosterone-treated than testosterone-naïve men.ConclusionsThe obtained results suggest that the beneficial effect on thyroid autoimmunity and thyroid secretory function is stronger in men receiving testosterone therapy.