甲状腺结节的临床分析

目的分析甲状腺结节的流行病学特点，评估现有方法对甲状腺良、恶性结节鉴别诊断的临床应用价值。方法对1?474例接受手术治疗的甲状腺结节患者资料进行回顾性分析，总结超声、术中冰冻和术后石蜡病理诊断的相关性，分析现有方法的临床价值。结果①1?474例患者中男286例，女1?188例。良性结节占77.40%，恶性者占22.60%；男性患者结节的恶性率高于女性患者（28.3% vs 21.3%，P<0.05）；②单、多发结节的甲状腺癌发生率分别为33.1%和27.6%，两者间差异无统计学意义（P=0.287）。结节边缘、内部结构、回声类型、内部微钙化、血流分布、颈淋巴结等超声特征在甲状腺良、恶性结节组的分布有统计学差异（P<0.001）；而周边缺乏声晕、内部粗钙化在良、恶性结节中的差异无统计学意义（P均>0.05）；③冰冻切片确诊率为96.0%，诊断甲状腺癌的敏感性为91.9%，假阴性率为0.5%。石蜡切片共发现微小癌67例，有26例发生了淋巴结转移，转移率为38.8%。结论甲状腺结节以女性高发，但男性恶性率高。超声检查有助于鉴别甲状腺结节的良恶性。术中冰冻检查对于明确甲状腺结节的良、恶性和术式的选择具有关键性作用，是一种较可靠的检查手段。

Clinical analysis of thyroid nodules

To analyze the epidemiological characteristics of thyroid nodules and to evaluate the value of the present methods for diagnosing thyroid nodules. MethodA retrospective study of 1?474 patients who had undergone surgery for thyroid nodules was made.  Results① There were 286 males and 1?188 females. 1?141(77.40%) patients were diagnosed with benign nodules and 333(22.60%) malignant nodules. The malignant rate was higher in males than in females（28.3% vs 21.3%, P<0.05）. ② The prevalence of thyroid cancer did not differ between patients with a solitary nodule and patients with multiple nodules (33.1% vs 27.6%, P=0.287). Those individual sonographic characteristics that showed a statistically significant difference in the malignant group were: ill defined margin, solid component, hypoechoic nodule, microcalcifications, internal blood flow and enlarged cervical lymph node(P<0.001). There were no differences between the benign and malignant groups for absent of halo and coarse calcifications (P>0.05). ③ The accuracy, sensitivity, and disaccording rate of frozen section examinations was 96.0%,  91.9%,  0.5%, respectively.  Microcarcinoma was found in 68 patients by paraffin section examination, of which 26(38.8%) had lymph node metastases. ConclusionThyroid nodules were found more often in women than in men,  but the malignancy rate was higher in men than in women. Ultrasonographic features could be helpful in differentiating benign and malignant nodules. Frozen section examination is of value in diagnosing thyroid nodules and plays a key role in determination of the extent of thyroidectomy.