原发性甲状腺功能亢进合并甲状腺癌的诊治

目的探讨原发性甲状腺功能亢进合并甲状腺癌的诊治方法及效果。方法原发性甲亢合并甲状腺癌15例,占同期手术治疗的原发性甲亢病例的4.1%(15/366)。术前经B超及细针穿刺细胞学检查确诊4例。行甲状腺全切术3例(其中1例合并颈部淋巴结肿大,行颈部淋巴结清扫术),另1例行患侧腺体+峡部切除并对侧腺体大部分切除。9例术中快速冰冻切片确诊,为甲亢并甲状腺微小癌,均行患侧腺体+峡部切除并对侧腺体大部分切除。2例仅行双侧甲状腺次全切除但术后病理发现癌变的患者,1例因是髓样癌在5 d内再次行患侧残留腺体切除术,另1例因是乳头状微小癌而未再行手术。结果随访12例,时间平均为5.3(1个月~14年),其中1例术后病理证实为滤泡状癌者术后1年内复发,再次行甲状腺全切除+颈部淋巴结清扫术,并加行放疗,目前仍存活,其余患者均无复发,存活至今。结论对某些特殊类型的甲亢患者应警惕癌变的可能,尽量在术前、术中确诊。甲亢合并的甲状腺癌预后较好,手术多以患侧全切+对侧次全切为主。

Diagnostic and Therapeutic Strategy for Primary Hyperthyroidism Combined with Thyroid Carcinoma

Objective To explore the diagnostic and therapeutic strategy for primary hyperthyroidism combined with thyroid carcinoma.Method 15 cases of primary hyperthyroidism combined with thyroid carcinoma were operated.Result All the patients survived during the 5.3-year follow-up,in whom one relapsed and got re-operated in one year after opeartion.Conclusions Canceration may occur in some specific primary hyperthyroidism.Hibateral subtotal thyreoidectomy is sufficient with a good prognosis to the majority of the pa...