桥本病合并甲状腺癌的诊疗体会(附16例报告)

目的总结桥本病(Hashimoto'sdisease,HD)合并甲状腺癌(thyroidcarcinoma,TC)的临床特点和诊治经验。方法回顾性分析1993年7月～2005年7月16例HD合并TC患者的临床资料。16例均于彩超下行细针穿刺,9例1次、3例2次针吸查见癌细胞;4例针吸阴性者,B超示包膜不完整而高度怀疑HD合并TC,行术中冰冻诊断确诊。16例均行患侧甲状腺腺叶及峡部全切、对侧甲状腺次全切除,其中3例加行同侧改良式颈淋巴结清扫。结果术后病理诊断HD合并乳头状癌13例、滤泡状癌3例。全组患者均有不同程度的甲状腺功能减退,常规行甲状腺替代和(/或)抑制治疗。术后并发轻度声音嘶哑1例,予营养神经药物和颈部理疗3月后好转。1例术后4年死于甲状腺癌转移,余15例健在。结论HD患者甲状腺触诊或怀疑有结节者可常规行超声检查或99mTc甲状腺扫描,超声引导下行细针穿刺细胞学检查对提高HD合并TC的诊断有较高参考价值;手术是最有效的治疗方法,一般采用患侧甲状腺及峡部全切加对侧甲状腺次全切除术,颈淋巴结肿大时可加行改良颈淋巴结清扫术;术后常规应用甲状腺素治疗可预防甲状腺功能低下。

Diagnosis and Treatment of Hashimoto''''s Disease Complicated with Thyroid Carcinoma (16 Cases Report)

Objective To explore the diagnosis and treatment of Hashimoto's disease(HD) complicated with thyroid carcinoma(TC). Methods 16 cases of HD complicated with TC were retrospectively reviewed. Fine needle aspiration biopsy were done in all cases, resulting in positive for cancer cell with 1 attempt in 9 cases and 2 attempt in 3 cases, while negative in 4 cases which highly suspected of cancer because characterized as poor capsule under ultrasound screening, and confirmed by intraoperative frozen section. All cases underwent total resection of tumor-bearing lobe and isthmus plus contralateral subtotal lobectomy, out of which 3 cases received cervical lymphatic clearance in the tumor-bearing side. Result Postoperative pathology revealed HD associated with papillary carcinoma in 13 cases and follicle carcinoma in 3 cases. Varied gravity of hypothyrosis was observed in all cases and was treated with replacement medication. Mild hoarse voice observed in 1 case and improved with 3 months of neurotrophy medication and physical therapy. All cases survived to the date except 1 case died of cancer recurrence 4 years postoperatively. Conclusion For HD, ultrasound or ~ 99mTc thyroid scan should be done in the presence of any suspected nodule under palpation, and can be further investigated by needle biopsy. Surgical resection is the optimal treatment.