手术治疗巨大结节性甲状腺肿18例体会

巨大结节性甲状腺肿可向胸骨及锁骨后方延伸,容易压迫气管及食管,产生相应的压迫症状,还可继发甲状腺机能亢进,也可发生恶变。我院1994年9月～1998年11月共收治巨大结节性甲状腺肿18例,现将临床特点及治疗过程介绍如下。1　临床资料11　一般资料本组18例病人,男性5例,女性13例。最大年龄70岁,最小年龄35岁,平均年龄43岁。所有病例均为双侧。其中有气管压迫症状者10例(555%),合并甲状腺机能亢进者6例(333%)。病史最长者30余年,最短者10余年。甲状腺呈结节状肿大,体积最小者13ｃｍ×7ｃｍ×6ｃｍ,最大者25ｃｍ×20ｃｍ×16ｃｍ。剖面有多房多…     

结节性甲状腺肿176例临床治疗分析

结节性甲状腺肿是较常见的甲状腺疾病,手术切除的范围和良性结节的复发是结节性甲状腺肿手术治疗中的问题所在。我们于1999～2009年对176例结节性甲状腺肿的临床治疗资料进行分析,现报告如下。     

结节性甲状腺肿1168例临床病理分析

目的探讨结节性甲状腺肿的临床病理特征。方法回顾性分析1 168例结节性甲状腺肿的临床病理资料。结果 1 168例结节性甲状腺肿中,女性患者占88.1%,中位发病年龄为48岁。结节性甲状腺肿伴发或继发病变发生率高达57.6%,其中出血、坏死、钙化、囊性变,灶性淋巴细胞增生及桥本甲状腺炎发生率分别为20.4%、28.0%和0.3%。乳头状增生发生率为5.3%,甲状腺癌继发率为3.1%。结论结节性甲状腺肿女性多发,继发病变多,诊断时应给予重视。     

结节性甲状腺肿合并甲状腺癌的临床诊治分析

目的:探讨结节性甲状腺肿合并甲状腺癌的诊断和治疗方法.方法:分析我院从2012年6月至2015年6月收治的经外科手术及病理证实的54例结节性甲状腺肿合并甲状腺癌患者的临床资料.结果:结节性甲状腺肿合并甲状腺癌占同期结节性甲状腺肿患者的14.9%(54/362).术前超声诊断阳性率为61.1%(33/54).手术方式包括患侧甲状腺全切除+峡部切除+对侧甲状腺部分切除+同侧淋巴结清扫(36例),患侧甲状腺全切+峡部切除(18例).54例患者中获随访48例,时间3月~36月,3例因颈部淋巴结肿大再次手术治疗,1例术后2年出现肺部转移.结论:超声检查对于术前诊断有重要意义,结合术前细针穿刺细胞学检查可进一步提高术前诊断率,结节性甲状腺肿合并甲状腺微小癌的临床诊断较困难,多于手术后病理诊断.结节性甲状腺肿合并甲状腺乳头状癌的患者手术治疗效果良好,预后较好.     

结节性甲状腺肿合并甲状腺微小癌32例临床分析

目的探讨结节性甲状腺肿合并甲状腺微小癌的临床特征及诊治方法。方法回顾性分析32例结节性甲状腺肿合并甲状腺微小癌病例的临床资料。结果 12例术前B超检查诊断为甲状腺微小癌,术中冷冻病理诊断为甲状腺微小癌18例,2例术后石蜡切片证实为甲状腺微小癌。术后石蜡切片诊断为乳头状癌30例,滤泡状癌2例。结论结节性甲状腺肿为临床常见病,术前B超检查、术中冷冻送病检有利于提高甲状腺微小癌的诊断率,甲状腺微小癌预后良好。     

结节性甲状腺肿合并甲状腺癌诊治分析

目的　总结结节性甲状腺肿合并甲状腺癌的诊治经验。方法　回顾性分析 2 3例结节性甲状腺肿合并甲状腺癌的临床资料。结果　同期手术治疗结节性甲状腺肿患者 83 6例 ,合并甲状腺癌 2 3例 ( 2 .75 % ,2 3 /83 6)。病理检查结果示 :灶性癌变 3例 ,微小癌变 8例 ,乳头状癌 11例 ,乳头状癌并滤泡状癌 1例。所有患者均行术中快速冷冻病理检查 ,并根据病理检查结果采取不同的手术方式 ,术后长期服用甲状腺素片。结论　结节性甲状腺肿临床中常见 ,但并发甲状腺癌诊断困难 ,多为分化好的乳头状癌。结节性甲状腺肿的手术指征应放宽 ,术中快速冷冻病理检查有利于选择正确的手术方式 ,使治疗合理有效     

227例甲状腺腺瘤与结节性甲状腺肿的临床病理分析

为提高对甲状腺腺瘤与结节性甲状腺肿的鉴别诊断水平。复查277例甲状腺腺瘤与结节性甲状腺肿病理切片，分析二者的不同病理特点，根据组织学标准重新做出诊断。原甲状腺腺瘤130例复查后仅有42例符合，其余均为结节性甲状腺肿。单结节性甲状腺肿易误诊为甲状腺瘤，要重视二者的鉴别诊断，以助于选择恰当的手术方式。     

358例甲状腺腺瘤与结节性甲状腺肿的临床病理分析

为提高甲状腺疾病的诊断水平对，对358例甲状腺腺瘤和结节性甲状腺肿进行复检和结果分析。复检前甲状腺腺瘤与结节性甲状腺肿之比为2．8：1，复检后2．8：1，原21例甲状腺肿误诊为腺瘤。     

结节性甲状腺肿合并甲状腺癌的临床特征分析

目的探讨结节性甲状腺肿合并甲状腺癌的临床特点和诊治措施,为临床治疗提供理论依据。方法收集并分析286例结节性甲状腺肿合并甲状腺癌患者的临床资料。结果 CT和超声检查的结果显示,结节性甲状腺肿合并单发甲状腺癌患者30例(10.5%),合并多发病灶的患者256例(89.5%),双侧病灶的患者135例(47.2%)。与结节性甲状腺肿组织特征相比,甲状腺癌结节边缘中断征(32%)、边缘不清(70%)和细颗粒状钙化(84%)的比例显著增高,差异均有统计学意义(均P<0.05)。乳头状癌202例,滤泡状癌50例,未分化癌32例,髓样癌2例,患者均无远隔器官的转移,其中N0期202例,N1期84例,T1期196例,T2期40例,T3期30例,T4期20例。所有患者均接受手术治疗,无严重并发症和死亡。结论在临床治疗中要高度警惕单侧孤立结节或存在钙化的甲状腺结节,应结合病理检查给予积极的手术治疗,以免结节恶化。     

结节性甲状腺肿与甲状腺癌并存的诊断与治疗(附68例临床报告)

目的　探讨结节性甲状腺肿与甲状腺癌并存的临床特点和诊治原则 ,进一步提高对该病诊断和治疗的认识。方法　回顾性分析 6 8例结节性甲状腺肿与甲状腺癌并存的临床资料。结果　本组病史平均 2 6 .6年 ;平均年龄 44.4岁 ;术前诊断率为 2 6 .4% ;伴发甲亢率为 5 .7% ;微小癌占 11.8% :以乳头状癌为主要病理类型。结论　病史长及年龄偏大的结节性甲状腺肿患者应想到合并甲状腺癌的可能性 ,此时结节性甲状腺肿的手术适应证应适当放宽 ;本病术前诊断率低 ,应重视术中对可疑结节的探查 ;并非一定行甲状腺癌根治术 ,根据术中冰冻结果采用相应术式。     

Correlation between thyroid function and nodular goiter accompanied with gallstone

The-purpose-of-the-study-wass-to-explore-the-correlation-between-thyroid-function-and-nodular-goiter-accompanied-with-gal-stone.-Methods:We-col-ected-120-cases-about-nodular-goiter-accompanied-with-gal-stone-and-128-cases-about-nodular-goiter-and-establish-50-healthy-control-groups.-Detected-t-level-of-hyrotropic-hormone-(TSH),-total-tri-o-dothyronine-(TT3),-total-thyroxine-in-the-peripheral-venous-blood-of-these-cases-in-the-three-groups-by-using-electrochemilu-minescence-immunoassay,-measure-level-of-total-cholesterol-(TC),-high-density-lipoprotein-cholesterol-(HDL-C),-low-density-lipoprotein-cholesterol-(LDL-C)-and-total-bile-acid-(TBA)-levels-by-using-enzymic-method,-and-observed-the-changes-of-thyroid-function-and-blood-lipid-among-the-three-groups.-Results:The-serum-TT3-level-in-nodular-goiter-accompanied-with-gal-stone-group-and-the-nodular-goiter-group-was-significantly-lower-than-that-in-control-group-(P<0.01),-and-TSH-level-in-the-nodular-goiter-accompanied-with-gal-stone-group-is-significantly-higher-than-that-in-control-group-(P<0.01).-There-were-no-statistical-significance-about-dif-erence-of-TT4-level-among-the-three-groups-(P>0.05).-Accordingly,-TC-and-LDL-C-level-in-nodular-goiter-accompanied-with-gal-stone-group-was-significantly-higher-than-that-in-nodular-goiter-and-control-group-(P<0.01),-while-TBA-level-in-nodular-goiter-accompanied-with-gal-stone-group-was-significantly-lower-than-that-in-simple-nodular-goiter-group-and-control-group-(P<0.01).-There-was-no-statistical-significance-about-dif-erence-of-TC-and-LDL-C-level-between-simple-nodular-goiter-group-and-control-group-(P>0.05).-The-HDL-C-level-in-nodular-goiter-accompanied-with-gal-stone-group-and-control-group-was-higher-than-that-in-simple-nodular-goiter-group-(P<0.01).-Conclusion:The-originating-etiologic-factor-of-nodular-goiter-accompanied-with-gal-stone-may-be-related-to-that-the-decreased-TT3-induced-sub-clinical-hypothyroidism.     

Changes of the blood lymphocyte population following 131I treatment for nodular goiter

The blood lymphocyte population was examined in 34 patients who were treated with 131I for toxic or atoxic nodular goiter. The patients received one to three doses of 300-550 MBq of 131I administered at 1 week intervals. Lymphocyte counts were significantly reduced both 1 and 6 weeks after treatment. This reduction was accompanied by a changed composition of the lymphocyte population. The frequency of lymphocytes expressing membrane receptors for C'3 (EAC-rosette forming) was significantly reduced 1 and 6 weeks after 131I-administration. At 6 weeks there was a slight but statistically significant increase of the frequency of T-cells as identified by Leu 1 monoclonal antibodies. This was largely caused by an increased proportion of helper/induced T-cells as identified by Leu 3a monoclonals. 131I-treatment also reduced the capacity of lymphocytes to secrete immunoglobulins (Ig) upon PWM-stimulation. The most pronounced effect was observed for IgM. Secretion of IgG and IgA were less reduced. Mitogenic stimulations of lymphocytes with PHA and ConA were not significantly changed. We conclude that these changes observed, with the exception of mitogen reactivity, are essentially similar to those occurring after external radiation therapy for cancer. We speculate that blood lymphocytes passing through the continuously irradiated gland are damaged mainly by emitted beta-particles.     

结节性甲状腺肿和甲状腺腺瘤的鉴别诊断

目的:探讨结节性甲状腺肿和甲状腺腺瘤的鉴别诊断。方法:回顾性分析兰州军区总医院2004年10月～2006年9月手术并经病理诊断的结节性甲状腺肿和甲状腺腺瘤病历资料。结果:结节性甲状腺肿112例,甲状腺腺瘤168例,术前结节性甲状腺肿正确诊断者7例,占6.25%,误诊为甲状腺腺瘤者105例,占93.75%,甲状腺腺瘤正确诊断者162例,占96.43%,误诊为结节性甲状腺肿者6例,占3.57%。结论:结节性甲状腺肿易误诊为甲状腺腺瘤,对结节性甲状腺肿大体形态认识上的偏差,查体不仔细,临床医师不认真分析或不认识结节性甲状腺肿和甲状腺腺瘤的B型超声波的回声特点是结节性甲状腺肿和甲状腺腺瘤误诊的主要原因。     

Incidence of carcinoma of the thyroid in nodular goiter

Since the incidence of cancer in nontoxic nodular goiter as reported by us in 1944 appeared high (17.1%), we made another study during the next four years and discovered an incidence almost identical (17.2%). Our figures on incidence of cancer in nontoxic nodular goiter appeared so high because we were the first authors to break down the goiters into the three different types and to discover that the incidence was high in only one type of goiter and not in the others. The incidence of cancer was only 4.6% in toxic nodular and toxic diffuse goiter added together. For decades, we have known that goiter is a geographic disease. It is possible that carcinoma of the thyroid is slightly geographical. At least it appears that there is a slightly geographical relationship in regard to the 16 patients we have observed in our clinic with cancer during 1944-1949; of these 16 patients, 11 had advanced malignant disease. We cannot have accurate figures on results regarding treatment of our cases until long-term follow-up is concluded.     

临床路径管理在结节性甲状腺肿住院患者中的应用

目的:探讨临床路径管理在控制结节性甲状腺肿患者住院费用及住院天数等方面的效果及应用价值。方法:采用回顾性队列研究的方式比较临床路径实施前、后结节性甲状腺肿住院患者的相关情况,主要评价指标包括,住院费用、住院天数、医疗质量等。结果:两组患者的临床与病理诊断符合率之间差异无统计学意义（P>0.05）,而路径组患者的住院并发症发生率明显低于对照组（P<0.05）。住院费用方面,路径组的平均住院总费用、药费、治疗费、材料费均少于对照组;住院天数方面,平均住院总天数和术后住院天数均少于对照组,差异有统计学意义（P<0.05）。结论:结节性甲状腺肿临床路径管理可以缩短平均住院日、降低住院费用、提高诊疗质量,值得进一步推广。