甲状腺微小癌48例临床病理分析

目的 :探讨甲状腺微小癌的病理特征及临床特点。方法 :对 48例甲状腺微小癌进行临床病理分析 ,常规制片HE染色。结果 :48例均为乳头状癌。大体标本 :切面呈灰白色 ,有的灰白色放射状瘢痕样 ,质地中等 ,部分较脆 ,无包膜。随访 43例健在 ,5例失访。结论 :甲状腺微小癌不少见 ,术前大多难以确诊 ,常在术后标本检查时被偶然发现 ,手术切除后预后良好。以锐刀每 0 .2cm作扇形切开 ,取下全部灰白区或瘢痕样组织做病理切片 ,可避免漏诊     

抗人甲状腺过氧化物酶抗体与其他自身抗体的关系

甲状腺过氧化物酶（ＴＰＯ）是甲状腺微粒体的抗原成分。在纯化抗原建立测定抗ＴＰＯ抗体ＥＬＩＳＡ法的基础上，并对抗ＴＰＯ与其他自身抗体的伴随关系作了研究。发现除自身免疫性甲状腺病有较高阳性率外，ＳＬＥ等患者抗ＴＰＯ检出率也很高（１０％￣５２．１％），且抗ＴＰＯ阳性者，抗核抗体等其他自身抗体的阳性率也高达３０．８％￣９５．２％。抗ＴＰＯ抗体与其他自身抗体的相关系数ｒ＝０．７４６７（Ｐ〈０．０１）。     

甲状腺手术中避免喉返神经损伤的实用解剖研究

对２０例单发良性甲状腺瘤手术进行了动态解剖学观察，主要针对侧叶切除术中喉返神经的有关解剖学关系进行测量分析，对术中处理甲状腺下动脉的方法提出与传统观念不同的意见认为术中游离并托起患侧叶，紧贴腺体切断甲状腺下动脉各分支，保留甲状腺下动脉主干的方式是避免喉返神经损伤的有益方式     

中西医结合治疗急性动脉栓塞过程中甲状腺激素测定的临床意义

目的：探讨甲状腺激素水平在急性动脉栓塞中中西医结合治疗过程中的变化规律及其临床意义。方法：利用放射免疫分析法对４０例本病患者及３０例健康对照组进行血清甲状腺激素测定，观察中西医结合治疗前后的变化，结果；４０例病人均存在在低Ｔ３、低Ｔ４和高ｒＴ３血症，且以重症病人最明显，Ｔ３水平低于０．５ｎｍｏｌ／Ｌ者病情危重，Ｔ４低于５０ｎｍｏｌ／Ｌ者预后不良；低Ｔ３、低Ｔ４和高ｒＴ３血症均随中西医结合有效治疗后     

甲状腺机能亢进症围手术期的处理

为探讨甲状腺机能亢进症的手术治疗效果，对１０３８例甲状腺机能亢进症病人的围手术期处理情况进行了分析。结果：术后无１例发生甲状腺危象。术后２年以上者９８０例，均获随访（１００％），随访时间为２～１５年，治愈率为９９．１％；复发９例，占０．９％。     

冠心病患者血清甲状腺激素变化及临床意义

观察３０例正常对照组１４例冠心病心衰患者，２０例冠心病心功能代偿期患者血清Ｔ３，Ｔ４，ｒＴ３，ＦＴ３，ＦＴ４，ＴＳＨ的变化，结果：两组患者与对照组比较，均有Ｔ３下降ｒＴ３升高，尤以冠心病心衰患者表现更明显，同时伴Ｔ４及ＦＴ３下降，有显著性差异，３组之间ＦＴ４比较无差异。结果提示：测定冠心病患者血清甲状腺激素水平，有助于了解病情的严重程度及判断其预后。     

C-TIRADS及BRAFV600E基因检测对细针穿刺细胞学难以定性的甲状腺结节的诊断价值

目的 探讨中国版甲状腺影像数据与报告系统（C-TIRADS）、BRAFV600E 基因检测及二者联合对细针穿刺细胞学难以定性的甲状腺结节的诊断价值。方法 纳入我院2020年1月—2021年4月的甲状腺手术患者53例行回顾性分析,术前完成超声、细针穿刺抽吸及BRAFV600E基因检测,选取细针穿刺细胞学难以定性的患者作为研究对象,53例患者共62个结节。以手术病理结果作为金标准,比较C-TIRADS、BRAFV600E基因检测及二者联合诊断对甲状腺结节的诊断效能。结果 C-TIRADS诊断甲状腺癌的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为92.50%、50.00%、77.08%、78.57%、77.42%。BRAFV600E基因诊断甲状腺癌的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为55.00%、100.00%、100.00%、55.00%、70.97%。C-TIRADS联合BRAFV600E基因诊断甲状腺癌的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为95.00%、50.00%、77.55%、84.62%、79.03%。C-TIRADS及联合诊断对甲状腺癌诊断的敏感性高于BRAFV600E基因检测（P<0.001）,BRAFV600E基因检测特异性及阳性预测值高于C-TIRADS及联合诊断（P<0.05）。C-TIRADS、BRAFV600E基因检测及联合诊断对甲状腺癌诊断的阴性预测值和准确性差异无统计学意义（P>0.05）。结论 C-TIRADS及BRAFV600E基因检测对于细胞学难以定性的甲状腺结节均有良好的诊断效能,术前联合应用可以更好地评估甲状腺结节     

The external laryngeal nerve: surgical and anatomic considerations. Report of 50 total thyroidectomies

This surgical anatomy study aimed to evaluate the possibility of identifying the external laryngeal nerve during thyroid surgery and the possible variations of nerves at risk. Fifty patients underwent total thyroidectomies during a period of 12 months. Using a neurostimulator, the distal motor branch of the external laryngeal nerve was searched. Electrical stimulation of a nervous branch aimed to provoke a global contraction of the cricothyroid in order to identify with certitude the external laryngeal nerve. The external laryngeal nerve was identified in 20% of cases. Its course was, with almost equal frequency, either (1) between the vessels of the superior thyroid pedicle or (2) superficial and anterior to the fascia of the cricothyroid muscle. The external laryngeal nerve is hard to find during thyroid surgery, even with a neurostimulator. It can be vulnerable during thyroid surgery but only in cases of anatomic variations. Searching for the nerve systematically during thyroid surgery does not seem to be useful. Several precautions when dissecting the superior pole of the thyroid gland seem to be necessary and sufficient to respect the external laryngeal nerve.     

Possible Relation of p53 and mdm-2 Oncoprotein Expression in Thyroid Carcinoma: A Molecular-Pathological and Immunohistochemical Study on Paraffin-Embedded Tissue

Routinely processed tissues from a series of benign and malignant thyroid lesions were immunohistochemically investigated with antibodies against p53 and mdm-2. p53 was immunolocalized in <10% of nuclei in 2/80 nodular goiters, 2/60 follicular adenomas, 26/68 follicular carcinomas, 7/40 papillary carcinomas, 3/10 “insular” carcinomas, and 10/31 anaplastic carcinomas. More than 10% positively stained nuclei were found in 2 widely invasive follicular, 2 insular, and 15 anaplastic carcinomas. All p53-positive cases showed a concomitant immunohistochemical mdm-2 expression; an immunohistochemical colocalization on serial section was demonstrated in 12 anaplastic carcinomas. Screening by polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) analysis of these 12 cases revealed no relevant mutations in the coding regions of exons 2–11 of the p53 gene. Additionally, 1 follicular adenoma, 6 follicular carcinomas (4 minimally and 2 widely invasive), 1 papillary, and 2 poorly differentiated insular carcinomas were mdm-2 positive without immunohistochemically detectable p53 expression. These results provide evidence that wild-type p53 expression in thyroid carcinomas may be associated with mdm-2 induced formation of stable complexes. However, the role of p53 mutations and p53 protein inactivation owing to other factors (e.g., mdm-2) in the progression of thyroid carcinomas is still poorly understood.     

甲状腺疾病患者血清可溶性白细胞介素2受体测定的临床意义

某些甲状腺疾病时血清可溶性白细胞介素２受体（ｓＩＬ－２Ｒ）水平及其与游离甲状腺素（ＦＴ＿４）、游离三碘甲腺原氨酸（ＦＴ＿３）和促甲状腺素（ＴＳＨ）水平的相关性比较。结果发现甲状腺机能亢进症（甲亢）未治疗组（Ａ）及甲亢未治疗伴突眼组（Ｄ）血清ｓＩＬ－２Ｒ明显升高；甲状腺机能减退症（甲减）经治疗甲状腺功能灭常组（Ｇ）ｓＩＬ－２Ｒ明显高于甲减未治疗组（Ｆ）；１０例毒性弥漫性甲状腺肿（Ｇｒａｖｅｓ病）患者经抗甲状腺药物治疗后ｓＩＬ－２Ｒ明显降低；Ｇｒａｖｅｓ病及甲减患者血清ｓＩＬ－２Ｒ均与ＦＴ＿３呈正相关。提示除自身免疫外，甲状腺素水平也是甲状腺疾病患者血清ｓＩＬ－２Ｒ水平的重要调节因素。