桥本病合并甲状腺癌的临床分析

目的探讨桥本病合并甲状腺癌的临床病理特点及手术治疗经验。方法回顾性分析本院1996年至2008年外科手术治疗的24例桥本病与甲状腺癌并存患者的临床病理特征以及手术方式的选择。结果桥本病与甲状腺癌并存发生率为12.8%(24/187),其中乳头状癌16例,滤泡状癌5例,混合性癌3例;微小癌7例,占29.2%;双侧甲状腺癌6例,占25%;中央区淋巴结转移13例,占54.2%。根据患者的术前检查结合术中冰冻确定手术方式,包括甲状腺腺叶及峡叶切除、甲状腺次全切除和甲状腺全切除,所有患者均同期行中央区淋巴结清扫。结论桥本病与甲状腺癌并存发生率较高,桥本病并发甲状腺癌术前确诊率低,尤其应警惕合并微小癌的可能。病史、细针针吸活检、彩色超声等综合分析有利于术前诊断,手术是其最有效的治疗方法。     

桥本病并发甲状腺肿块的外科治疗

目的：总结并发甲状腺肿块的桥本病的外科治疗经验。方法：回顾分析手术并经病理证实的142例桥本病患者的临床资料。结果：全组病例均因甲状腺肿块而接受手术,病理证实合并甲状腺乳头状癌28例,恶性淋巴瘤2例,甲状腺腺瘤样结节7例,结节性甲状腺肿16例,甲状腺功能亢进12例。合并症为65例,占45.8%。单纯桥本病77例。结论：合并甲状腺肿块的桥本病,常需手术治疗,手术方式和手术切除范围应根据术中冰冻切片的结果而定,特别要警惕并存甲状腺癌的可能,要注意甲状旁腺的保护。     

桥本病及其共存的甲状腺疾病诊治分析

目的 总结桥本病及其共存的甲状腺疾病的诊治经验。方法 回顾我院1984年1月至2001年6月外科手术治疗的桥本病138例，分析52例与桥本病共存的甲状腺疾病的临床资料。结果 52例均并发甲状腺结节，其中桥本病并存甲状腺癌17例（12．32％），淋巴瘤2例（1．62％），甲状腺腺瘤5例（3．62％），甲状腺机能离进2例（1．62％），结节性甲状腺肿26例（18．84％）。采取了不同范围的手术方式。术后均服用甲状腺素片并随访，淋巴瘤死亡1例，甲状腺功能低下1例。结论 对于合并甲状腺结节才，应手术治疗排除甲状腺恶性肿瘤的可能，术中快速病理检查是获得正确诊断的有效方法，有利于选择适当的手术方式。     

桥本病并发其他甲状腺疾病外科治疗探讨

目的总结桥本病并发其他甲状腺疾病的手术治疗经验。方法1984—2003年手术治疗189例桥本病，对其中76例并发甲状腺其他疾病的桥本病进行回顾性分析。结果76例均并发甲状腺结节，其中桥本病并存甲状腺癌24例（31．58％），淋巴瘤3例（3．95％），甲状腺腺瘤8例（10．53％），甲状腺机能亢进2例（2．63％），结节性甲状腺肿38例（50．00％），淋巴组织非典型增生1例（1、32％）。根据病理检查采取了不同范围的手术方式。术后均服用甲状腺素片，并随访。因患淋巴瘤死亡1例，甲状腺功能低下3例。结论对于合并甲状腺结节的桥本病应行手术治疗，术中快速病理检查是获得正确诊断的有效方法，利于选择适当的手术方式．手术中应尽量保留正常的甲状腺组织，防止甲状腺功能低下。     

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目的　探讨并发甲状腺结节的桥本病外科治疗的临床效果。方法　总结 1985年 1月至 1999年 6月外科手术治疗并经病理证实的桥本病 10 0例 ,分析手术方式和范围与术后疗效和甲状腺机能减退 (下称甲减 )之间的关系。结果　全组病例均并发甲状腺结节 ,其中甲状腺癌 (下称甲癌 ) 10例 ,甲状腺瘤 (下称甲瘤 ) 8例 ,甲状腺机能亢进 (下称甲亢 ) 14例 ,结节性甲状腺肿 18例 ,其余为桥本病淋巴瘤样肿结节。根据不同情况均采取了不同范围的甲状腺切除术 ,其中一侧或双侧甲状腺全切除和次全切除术所占比例达 71%。全组病例服用甲状腺素随访 2年 ,无甲减发生。 6 7%的病例可停药。术后随访 5年 ,除并发甲癌者继续服药外 ,其余均停药 ,只有 2例出现甲减。结论　并发甲状腺结节的桥本病应予以手术治疗 ,手术方式应根据具体情况而定 ,术后 5年甲减发生率低     

桥本病合并甲状腺癌的诊治

目的探讨桥本病合并甲状腺癌的诊断和治疗方法。方法回顾分析我院1993～2004年收治的15例桥本病合并甲状腺癌的临床资料。结果桥本病合并甲状腺癌的发病率占桥本病的13.4%(15/112),所有15例病人均主诉有颈部结节,13例TGA及TMA升高。手术方式主要为一侧或双侧甲状腺全切或次全切除。术后随访复发1例,转移2例。结论桥本病合并甲状腺癌术前诊断困难,术前常规检查TGA及TMA、术中常规作冰冻切片有助于提高桥本病的诊断。手术是最有效的治疗方法,应采取甲状腺癌根治性手术原则进行。     

桥本病合并甲状腺癌的诊治体会

目的 探讨桥本病合并甲状腺癌的诊断和治疗方法.方法 回顾分析74例桥本病合并甲状腺癌的临床资料.结果 2002年1月-2009年8月共收治252例桥本病,其中74例为桥本病合并甲状腺癌,均为乳头状癌,其中56例TGAb升高,68例MeAb升高,74例TPOAb升高.手术行患侧甲状腺全切除、峡部切除加对侧次全切除术45例,双侧甲状腺近全切除术1例(峡部癌).26例微小癌行甲状腺次全切除术或一侧腺叶全切除,2例双侧癌行双侧甲状腺全切除.所有病例同时行中央区淋巴结清扫,中央区淋巴结转移率20/74(27%).10例因患侧颈淋巴结转移行一侧颈部淋巴结改良清扫术.69例获得随访,随访时间1个月-7年,中位随访时间29个月.4例患者因发生一侧颈淋巴结转移而再次入院行改良颈淋巴清扫术. 结论'TGAb、McAb、B超、FNAB对术前诊断桥本病合并甲状腺癌有重要价值,手术应按甲状腺癌根治原则进行.     

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目的 探讨桥本病合并甲状腺恶性肿瘤的临床发病关系及其诊断，治疗和预后。方法 回顾1984－2001年138例桥本病合并甲状腺恶性肿瘤19例，结合文献进行临床分析。结果 发病率为13．77％（19／138）。其中桥本病合并甲状腺癌17例，发病率为12．32％，合并淋巴瘤2例，发病率为1．45％。全组病人均出现甲状腺结节，经手术治疗后并随访淋巴瘤死亡1例，甲状腺癌17例随访无死亡及复发，预后好。结论 对于合并甲状腺结节的桥本病应考虑手术治疗。桥本病合并甲状腺恶性肿瘤临床诊断较困难。术前常规测血TGA，MCA，甲状腺核素显影，细针穿刺，术中快速冰冻切片，有利于术前，术中确诊及正确的手术方式选择。     

结节性甲状腺肿合并甲状腺癌38例诊治分析

目的 探讨结节性甲状腺肿合并甲状腺癌的诊治方法.方法 回顾性分析我院2000年1月至2006年12月手术治疗的635例结节性甲状腺肿病例中38例并存甲状腺癌患者的临床资料.结果 同期手术治疗结节性甲状腺肿患者635例,合并甲状腺癌38例(5.98%),病理检查结果:微小癌变17例,双叶癌7例,乳头状癌23例,滤泡状癌7例,髓样癌4例,未分化癌3例,甲状腺肉瘤样伴鳞癌分化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.结论 结节性甲状腺肿术前检查怀疑甲状腺癌者应行细针穿刺及术中快速冰冻切片病理检查有利于确诊,可有效避免再次手术;甲状腺全切 131I放射治疗残余灶和/或转移灶 足量L-型甲状腺素钠抑制治疗有利于降低复发和死亡.     

甲状腺疾病并存局灶性淋巴细胞性甲状腺炎57例临床分析

目的总结甲状腺疾病并存局灶性淋巴细胞性甲状腺炎的诊治方法，并探讨其与桥本病混淆的原因。方法对近25年间经手术治疗病理诊断为桥本病的207例患者中，143例桥本病合并其他甲状腺疾病的临床资料进行回顾性分析。结果143例中57例为甲状腺疾病并存局灶性淋巴细胞性甲状腺炎，占桥本病的27．5％（57／207），占桥本病合并其它甲状腺疾病的39．9％（57／143）。术中病理切片显示局灶性淋巴细胞浸润的阳性率为87．7％（50／57）。术后甲状腺功能减退（甲减）的发生率为19．3％（11／57）；其中亚临床型甲减7例，占12．3％（7／57）。结论甲状腺疾病并存局灶性淋巴细胞性甲状腺炎与甲状腺疾病并存桥本病两者病理改变的性质可能不同。术中切片检查有助于该病的诊断，并对指导手术切除腺体的范围具有重要的意义。     

The incidence of thyroid carcinoma in Hashimoto's thyroiditis

The incidence of thyroid carcinoma in Hashimoto's thyroiditis has been a widely debated issue. Previous authors have reported on this topic by analyzing series of patients with Hashimoto's thyroiditis or patients with thyroid carcinoma, but not both of those populations in the same series. The population consists of a consecutive series of 800 patients operated on for thyroid nodules not associated with a radiation history. Among 161 patients with the diagnosis of thyroid carcinoma, 61 (38%) had coexistent Hashimoto's thyroiditis. In comparison, among 161 sex- and age-matched patients with colloid nodules in the same population, 18 (11%) had Hashimoto's thyroiditis. Furthermore, in the series as a whole, the incidence of Hashimoto's thyroiditis in 423 patients with colloid nodules was 10 per cent. From the perspective of the Hashimoto's thyroiditis population in the same series of 800 thyroidectomies, among 267 patients with Hashimoto's thyroiditis 61 (23%) had coexistent carcinoma. In comparison, among 267 age- and sex-matched patients with colloid nodules there were only ten coexistent carcinomas for an incidence of 4 per cent. The high incidence of carcinoma of the thyroid in Hashimoto's thyroiditis lends credence to the hypothesis that Hashimoto's thyroiditis is a predisposing factor in the development of thyroid carcinoma.     

桥本病合并甲状腺结节的外科治疗

目的 探讨桥本病(HD)并存甲状腺结节的诊治经验.方法 回顾分析我院1995年至2008年手术治疗的,以结节形式为主要症状的187例HD的临床资料.结果 HD并存甲状腺癌21例(11.2%),结节性甲状腺肿50例(26.7%),甲状腺滤泡性腺瘤28例(15%),淋巴瘤3例(1.6%),采取了不同范围的手术方式,术后均服用甲状腺素片.结论 对于HD并存甲状腺结节尤其单结节患者,如临床资料不能除外恶性肿瘤均应积极手术.B超及细胞学穿刺有助于术前诊断,而术中快速病理检查是确诊的有效方法,并指导手术方案的制定.     

Thyroid pathology associated with primary hyperparathyroidism

BACKGROUND: Thyroid carcinoma and benign thyroid disease associated with primary hyperparathyroidism (PHPT) have been well described. With the developing trend toward minimally invasive parathyroidectomy without intra-operative thyroid gland palpation, thyroid pathology may be missed. The authors consider it timely to revisit the issue of thyroid pathology found at neck exploration for PHPT. METHODS: A retrospective review of all cases of neck exploration for PHPT between 1993 and 1998 at Liverpool Hospital was undertaken. RESULTS: There were 65 patients in the study group (44 women, 21 men; mean age: 59 years). The most common indication for surgery was asymptomatic hypercalcaemia. The mean pre-operative calcium level was 2.9 mmol/L and the mean parathyroid hormone (PTH) level was 17 pmol/L. There were 26 cases (40%) of coexistent thyroid pathology. Ten cases (15%) were of mild multinodular change, seven cases (11%) were of severe multinodular change requiring thyroidectomy, three cases (4%) were nodules secondary to Hashimoto's thyroiditis and six cases (10%) were suspicious nodules that proved to be either adenomas (n = 3) or carcinomas (n = 3) following excision. There were four papillary carcinomas detected in the present series with a mean metastases, age, completeness of excision, invasion size (MACIS) score of 4.92. CONCLUSION: A 25% association of significant thyroid pathology with PHPT is reported. Despite pre-operative tests there were two cases (4%) of thyroid carcinoma where the decision to resect the thyroid gland was made following intra-operative thyroid gland palpation. One of these two papillary carcinoma patients would have fulfilled criteria for minimally invasive parathyroid surgery. When evaluating results of minimally invasive parathyroid surgery one must be aware of the potential for missed thyroid pathology.     

慢性淋巴细胞性甲状腺炎的诊断和治疗

目的:降低慢性淋巴细胞性甲状腺炎的误诊率,选择适宜治疗。方法:回顾性总结1981年—1998年间收治的非典型桥本病64例。结果:64例仅12例未手术,余52例均手术。术后病理结果:单纯桥本病31例,桥本病合并甲状腺腺瘤4例,桥本病合并结节性甲状腺肿12例,桥本病合并甲状腺机能亢进症3例,桥本病合并癌2例。结论:本病误诊率较高,检测TGAB和McAB、细针穿刺活检和甲状腺干制剂诊断性治疗三者结合有助于提高本病的正确诊断率。对有压迫症状或合并其他甲状腺疾病者,可予手术治疗。术中行冰冻病理可明确诊断并确定手术方式,术中应尽量保留正常甲状腺组织,以防术后产生甲状腺功能减低。     

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。     

42例桥本病的诊断和外科治疗分析

目的　探讨桥本病的临床诊断、手术适应证及手术范围。方法　对 1993至 2 0 0 2年间收治的 42例桥本病的临床资料进行回顾性分析。结果　其中 3 2例行手术治疗。术后病理结果 :桥本病 2 0例 ,桥本病合并甲亢 2例 ,结节性甲状腺肿 4例 ,甲状腺腺瘤 4例 ,甲状腺乳头状癌 2例。结论　对桥本病应采用综合诊断的原则 ,将甲状腺自身抗体检测、细针穿刺活检和甲状腺干制剂诊断性治疗有机的结合有助于提高术前诊断率。对有气管压迫症状或怀疑合并其他甲状腺疾病者 ,可予手术治疗。强调术中快速病理检查帮助诊断并选择手术方式 ,尽可能减少术后甲状腺功能减退的发生率。     

Surgical treatment of Hashimoto's thyroiditis. Personal experience

BACKGROUND: To report personal experience in the surgical treatment of Hashimoto's thyroiditis. METHODS. Eight patients (7 females, 1 male, mean age 48 years old) referred to our Institution with diagnosis of Hashimoto's thyroiditis have been studied. All patients were evaluated by determination of serum thyroid hormones and of anti-thyreoglobulin and anti-microsomal antibodies; ultrasound and scintigraphic scans of the gland were performed in all cases and a cytological examination of fine needle aspiration (FNAC) of the nodules was evaluated. Diagnosis of Hashimoto's thyroiditis was suspected on the basis of clinical and laboratory data and was confirmed by cytology and histology on surgical specimens. Preoperative FNAC showed a Hashimoto's thyroiditis with thyroid differentiated carcinoma in 3 cases (37.5%), Hashimoto's thyroiditis in 1 case and chronic thyroiditis in 4 cases (50%). Seven patients underwent surgery, while 1 patient received a medical treatment; we performed 6 total thyroidectomies and 1 hemithyroidectomy. Histology on surgical specimens confirmed the diagnosis of Hashimoto's thyroiditis in all cases; in 3 patients an associated papillary thyroid carcinoma was found. RESULTS: Postoperative mortality was absent; no major postoperative complications (laryngeal nerve paralysis or permanent hypocalcemia) were recorded. Only 2 mild transient hypocalcemias have been observed. CONCLUSIONS: Total thyroidectomy is the technique of choice in surgical treatment of Hashimoto's thyroiditis, a self-immune pathology which involves the whole gland and has a high correlation with differentiated thyroid carcinoma (37.5%). Total thyroidectomy warrants a radical and definitive control of the disease, without risk of relapse, with a low incidence of major complications, in experienced hands, and anyway lower than the morbility due to reinterventions.     

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??Surgical treatment for Hashimoto diseases: an analysis of 183 cases WU Ling-yan, XU Shao-ming, WANG Ping, et al. The Second Hospital Affiliated to ZheJiang University, HangZhou 310009, China
Corresponding author??LI Zhi-yu, E-mail??yugehdh@163.com
Abstract Objective To explore the diagnosis and treatment of Hashimoto disease(HD) and its complications. Methods The clinical data of 183 cases of pathology proved HD admitted between January 1999 and October 2007 at the Second Hospital Affiliated to Zhejiang University were analyzed retrospectively. Results All the cases received surgeries. Among them, 104 cases were simple HD. Forty-nine cases were found also suffering from thyroid carcinoma besides HD (with a concurrent rate of 26.7%), and 15 from thyroid nodules (8.2%), 8 from thyroid adenoma (4.4%), 7 from Graves disease (3.8%). The way of surgeries were decided by the location and results of FS. According to the final pathological report, the accuracy of diagnosis about HD before surgeries was 78.7%, about TC was 53.1%. The accuracy of diagnosis about HD according to FS was 95.6%, and about TC was 95.9%. All the cases were followed up for an average period of 3.8 years. One of the PTMC suffered local recurrence 2 years after sub-resection of both sides of thyroid tissue. Another of HD was found recurrence 4 years after surgery. All other cases were all alive without recurrence. Conclusion The diagnosis of HD depends on analysis of clinical feature, examination of serum antibodies, and FNAC or frozen section in operation. HD is likely to have complications. It should pay attention to TC, especially PTMC.