单侧腺叶及峡部切除术后甲状腺功能的临床研究

单侧腺叶及峡部切除术是治疗甲状腺单发结节的最佳术式,但甲状腺单发良性结节行单侧腺叶及峡部切除术后,是否会出现甲状腺功能减退（以下简称甲减）,是否需应用甲状腺素进行补充治疗,目前国内外未见文献报道.为此,我们对单侧腺叶及峡部切除术后,病理证实为单发良性结节患者不同时段的甲状腺功能及影响因素进行了前瞻性研究,现报告如下.     

甲状腺单发结节50例手术方式探讨

目的探讨甲状腺单发结节的手术方式。方法回顾性分析1996年1月至2006年12月收治的50例甲状腺单发结节手术治疗患者的病例资料。结果单纯结节摘除12例，术后病检甲状腺癌1例，到上级医院二次手术；病侧腺叶部分切除8例，术后1例又因腺瘤复发于8年后行病侧腺叶加峡部切除手术。1例因病检为甲状腺癌而到上级医院二次手术；病侧腺叶切除加峡部切除30例，术后病检甲状腺癌2例，均到上级医院会诊予以观察，1例随访2年，另1例随访6年未复发。出现喉返神经损伤症状（声音嘶哑伴饮水呛咳）1例，于术后3个月恢复正常。无甲状腺功能减退症状发生。临床疗效满意。结论病侧腺叶切除加峡部切除是治疗甲状腺单发结节的一种安全有效的手术方式。     

甲状腺微小癌28例诊治分析

目的:探讨甲状腺微小癌的诊治经验.方法:回顾性分析1997年1月-2005年12月收治的28例甲状腺微小癌的临床资料.结果:该组28例中20例合并甲状腺其他良性病变,3例伴有颈淋巴结转移.24例术中冰冻切片诊断甲状腺微小癌,另4例术后病理确诊.单发癌结节26例,多发癌结节2例.18例行患侧甲状腺腺叶全切除加峡部切除及对侧腺叶次全切除术,3例加行患侧功能性颈清扫术,4例行患侧腺叶次全切除术,2例行双侧腺叶加峡部全切除术,1例行峡部切除加两侧腺叶次全切除术.随访22例,时间15月-144月,平均76月,2例复发,无死亡.结论:术前触诊、B超检查、术中探查及冰冻组织切片对提高甲状腺微小癌的诊断非常重要,患侧甲状腺腺叶全切除加峡部切除及对侧腺叶次全切除术为主要理想手术方式,一般不作预防性颈清扫术,不作全甲状腺切除.     

甲状腺单发结节手术方式的探讨（附50例报告

 目的　探讨甲状腺单发结节的手术方式。方法　回顾性分析1996年1月至2006年12月收治的50例甲状腺单发结节手术治疗患者的病例资料。结果　单纯结节摘除12例，术后病检甲状腺癌1例，到上级医院二次手术；病侧腺叶部分切除8例，术后1例又因腺瘤复发于8年后行病侧腺叶加峡部切除手术。1例因病检为甲状腺癌而到上级医院二次手术；病侧腺叶切除加峡部切除30例，术后病检甲状腺癌2例，均到上级医院会诊予以观察，1例随访2年，另1例随访6年未复发。出现喉返神经损伤症状（声音嘶哑伴饮水呛咳）1例，于术后3个月恢复正常。无甲状腺功能减退症状发生。临床疗效满意。结论　病侧腺叶切除加峡部切除是治疗甲状腺单发结节的一种安全有效的手术方式。     

分化型甲状腺癌再次手术原因探讨(附82例病例报告)

目的　探讨分化型甲状腺癌的术前正确诊断和合理的手术术式选择。方法　对 82例分化型甲状腺癌再次手术的临床资料进行回顾性分析。结果　术前 69例误诊为甲状腺瘤 ,11例误诊为结节性甲状腺肿。首次手术行单纯性肿瘤切除 5 9例 ,患叶甲状腺次全切除 13例 ,9例行腺叶加峡部切除。术前、术中 80例未做细胞及病理学检查。结论　对甲状腺结节患者 ,应行细针穿吸 (FNAC)及术中冰冻切片 (FS)检查。并重视区域淋巴结的检 (探 )查 ,以确定分化型甲状腺癌诊断 ,根据病期选择手术术式。如无条件行FNAC及FS ,对一叶单发或多发甲状腺结节的可疑病例 ,宜选择甲状腺叶加峡部切除术术式治疗     

分化型甲状腺癌再次手术原因探讨（附82例病例报告）

目的：探讨分化型甲状腺癌的术前正确诊断和合理的手术式选择。方法：对82例分化型甲状腺癌再闪手术的临床资料进行回顾性分析。结果：术前69例误诊为甲状腺瘤，11例诊为结节性甲状腺肿，首次手术行单纯性肿瘤切除59例，患叶甲状腺次全切除13例，9例行腺叶加峡部切除。术前，术中80例未做细胞及病理学检查，结论：对甲状腺结节患，应用细针穿吸（FNAC）及术中冰冻切片（FS）检查，并重视区域淋巴结的检（探）查，以确定分化型甲状腺癌诊断，根据病期选择手术术式，如无条件行FNAC及FS，对一叶单发或多发甲状腺结节的可疑病例，宜选择甲腺叶加峡部切除术术式治疗。     

甲状腺单发结节腺叶切除750例分析

本文对甲状腺单发结节腺叶加峡部切除７５０例做了分析，其中良性病变６１４例（８１．８％），恶性肿瘤１３６例（１８．２％）经随访１～１６年未见复发。该资料表明该术式操作简便、安全，疗效可靠，可避免肿瘤单纯挖除术所造成的二次手术之痛苦。     

分化型甲状腺癌126例临床分析

目的:研究分化型甲状腺癌适宜的切除范围和手术方式。方法:回顾性分析我院1993年1月-2000年7月治疗的分化型甲状腺癌126例,并对肿瘤残留和复发情况进行分析。结果:行单侧腺叶加峡部切除或全甲状腺切除术的5年复发率为6.76%,对侧腺叶的复发率为1.35%。局部肿块切除或腺叶部分切除的肿瘤残留率为61.54%,5年复发率为19.23%。局部肿块切除或腺叶部分切除术的患者再次手术后的复发率显著高于单侧腺叶加峡部切除或全甲状腺切除术患者(P<0.05)。结论:单侧腺叶加峡部切除术或全甲状腺切除术应作为甲状腺癌首选手术治疗方式,局部肿块切除或腺叶部分切除术肿瘤残留率较高,再次手术是必要的。选择正确的手术方式可降低术后复发率。     

低位小切口甲状腺手术16例分析

目的　探讨一种微创、美观的甲状腺手术方法。方法　 16例甲状腺手术采用低位小切口 ,对传统手术操作方法进行某些改进。结果　本组 16例 ,切口选择在胸骨上 1～ 1 5cm ,长度 4～ 5cm ,行一侧腺叶加峡部切除术 12例 ,加对侧腺叶部分切除术 2例 ,对侧腺叶结节剜除术 2例 ,手术均获成功 ,无并发症发生 ,随访 3～ 6个月 ,见手术切口瘢痕细小、美观。结论　低位小切口甲状腺手术简单、易行 ,采用适当方法操作 ,并不增加手术难度 ,可完成常规手术切口切除范围 ,而且美容效果好。     

低位小切口甲状腺手术16例分析

目的 探讨一种微创、美观的甲状腺手术方法。方法 16例甲状腺手术采用低位小切口，对传统手术操作方法进行某些改进。结果 本组16例，切口选择在胸骨上1～1.5cm，长度4～5cm，行一侧腺叶加峡部切除术12例，加对侧腺叶部分切除术2例，对侧腺叶结节剜除术2例，手术均获成功，无并发症发生，随访3～6个月，见手术切口瘢痕细小、美观。结论 低位小切口甲状腺手术简单、易行，采用适当方法操作，并不增加手术难度，可完成常规手术切口切除范围，而且美容效果好。     

Association of insulin-like growth factor-1 with thyroid nodules

The aim of the present study was to investigate the relationship between insulin-like growth factor-1 (IGF-1) and thyroid nodules. A total of 56 patients with thyroid nodules confirmed by physical examination and ultrasound screening were randomly selected. The patients were divided into three groups by radionuclide scan: the hot nodule group (group 1, n=18); the cold and solid nodule group (group 2, n=18); and the cold and cystic nodule group (group 3, n=20). Cystic fluid samples from patients with cystic cold thyroid nodules were defined as group 4. A control group of 18 healthy adults matched for age, gender and body mass index (group 0) was also included. For all participants, levels of the thyroid hormones, TT3, TT4, TSH and IGF-1, were determined by radioimmunoassay. The measurement data were expressed as the mean ± standard deviation (SD). The analysis of variance was performed by the t-test and the correlation analysis was performed by linear regression. The serum levels of IGF-1 in the solid cold nodule group were significantly higher than those in the hot nodule group (P<0.05). Serum levels of IGF-1 in the cystic cold nodule group were significantly lower than those in the control group (P<0.05). The serum IGF-1 levels in the cystic fluid were significantly lower than those in the cystic cold nodule (P<0.05) and the control groups (P<0.05). Additionally, the mean serum IGF-1 level in patients with thyroid adenoma was significantly higher than that in the control group (P<0.05). The serum IGF-1 level may not be involved in the pathogenesis of hot thyroid nodules and cold and cystic thyroid nodules; however, it may play a significant role in the pathogenesis of certain solid cold thyroid nodules.     

A comparative study of fine needle aspiration cytology, ultrasonography and radionuclide scan in the management of solitary thyroid nodule : A prospective analysis of fifty cases

Solitary thyroid nodule is a common clinical entity encountered by the otorhinolaryngologist and physcians. The optimum diagnostic strategy for the euthyroid patient with a soilitary thyroid nodule is still a matter of debate. The goal of diagnostic workup now is to select those patients for surgery who have a high likelihood of harbouring malignancy in the solitary thyroid nodule. The present study was undertaken to evaluate the utility of FANC in the preoperative diagnosis of solitary thyroid nodule and to evaluate the efficacy of FNAC, VSG and RNS in differentiating between benign and malignant nodules. It was found that FNAC is a safe, reliable and cost effective diagnostic modality with a high sensitivity of 83.3% and specificity of 100% and is the single best investigation for preoperative evaluation of solitary thyroid nodules to differentiate between benign and malignant nodules.     

Technetium Pertechnetate Imaging in Apparent Solitary Thyroid Nodule

^99mTc-pertechnetate rectilinear scans of the thyroid were performed in 272 patients judged to have solitary thyroid nodules on palpation. Eighty percent of these patients were shown to have decreased uptake in a single thyroid nodule. Further analyses were made among 82 patients who had surgery for such nodules. Again, 90 percent of these showed the scintigraphic appearance of focal decrease in uptake. Among these 82, histological evidence of carcinoma (follicular, papillary or mixed) was seen in 31 cases (37.8%), a further 31 cases showed follicular adenoma while 3 had autoimmune thyroiditis and 8 showed simple cysts. We conclude the hypofunctioning solitary nodule without clinical evidence of malignancy need not always be cancerous but the incidence I have demonstrated is high enough to warrant surgery in all patients with a palpable single nodule with reduced isotope uptake.     

Cold nodule thyroid — A 5 year retrospective study

FNAC and histopathological reports of 50 patients with cold nodule thyroid who underwent surgery during the last 5 years were analysed. FNAC showed malignancy in 12% of cases whereas histopathological examination in 16% of cases. In this study an attempt has been made to find out the role of frozen section in cold nodule thyroid.     

Management of the solitary thyroid nodule

Thyroid nodules are common, with up to 8% of the adult population having palpable nodules. With the use of ultrasound, up to 10 times more nodules are likely to be detected. Increasing numbers of nodules are being detected serendipitously because of the rising use of imaging to investigate unrelated conditions. The primary aim in investigating a thyroid nodule is to exclude the possibility of malignancy, which occurs in about 5% of nodules. This begins with a thorough history, including previous exposure to radiation and any family history of thyroid cancer or other endocrine diseases. Clinical examination of the neck should focus on the thyroid nodule and the gland itself, but also the presence of any cervical lymphadenopathy. Biochemical assessment of the thyroid needs to be followed by thyroid ultrasound, which may demonstrate features that are associated with a higher chance of the nodule being malignant. Fine-needle aspiration biopsy is crucial in the investigation of a thyroid nodule. It provides highly accurate cytologic information about the nodule from which a definitive management plan can be formulated. The challenge remains in the management of nodules that fall under the "indeterminate" category. These may be subject to more surgical intervention than is required because histological examination is the only way in which a malignancy can be excluded. Surgery followed by radioactive iodine ablation is the mainstay of treatment for differentiated thyroid cancers, and the majority of patients can expect high cure rates.     

Diagnosis and management of patients with thyroid nodules

Fewer than 5% of all adults will have a palpable thyroid nodule, but this is still a large number of individuals who require evaluation. Although most thyroid nodules are a result of a benign disease process (more than 95%), the possibility of thyroid cancer is always a consideration. Important aspects of history taking with a patient in whom a thyroid nodule has been noted include age, gender, family history of thyroid or endocrine disease, prior low dosage head and neck radiation, recent hoarseness, dysphagia, and symptoms of hypermetabolism. Key features of evaluation by physical examination are the size and location of the thyroid abnormality, the degree of firmness of the nodule, the presence of other nodules in the thyroid, palpable cervical lymph nodes, vocal cord paresis or paralysis, and tachycardia and/or tremor.The major categories of thyroid abnormality in such patients include cysts, adenomas, thyroiditis, and cancer. Although radionuclide scans, ultrasound examination and computer tomography have all been employed in the assessment of thyroid nodules, and thyroid stimulating hormone assay is useful for confirming a euthyroid state, fine needle aspiration biopsy (FNAB) has proved to be the most efficient diagnostic tool. The findings from FNAB allow avoidance of operative treatment for a large portion of these patients with palpable thyroid nodules, but a diagnosis of "follicular neoplasm" on FNAB usually requires operation, despite the fact that many such patients do ultimately prove to have a benign lesion. The extent of operation in patients undergoing surgery will depend on the diagnostic findings before operation, but unilateral thyroid lobectomy is the minimum procedure when surgery is required.     

代谢综合征与分化型甲状腺癌的发生及严重程度的相关性

目的:分析代谢综合征及其组分与分化型甲状腺癌的发生及严重程度的相关性。方法:收集自2020年06月至2022年06月在我院因甲状腺结节行手术治疗，术后病理确诊为分化型甲状腺癌的285例患者以及病理确诊为良性甲状腺结节的138例患者的临床资料，根据病理结果，分为良性组138例和恶性组285例；根据是否合并代谢综合征，将恶性组患者分为甲癌组156例和甲癌合并代谢综合征组129例。结果:恶性组患者BMI平均数及代谢综合征占比明显高于良性组，恶性组年龄平均数低于良性组，且存在显著性差异（P＜0.05）；甲癌合并代谢综合征组患者较甲癌组体质量指数、血压、空腹血糖、甘油三酯、肿瘤直径≥1、肿瘤位于双侧甲状腺、肿瘤多灶均高（P＜0.05），高密度脂蛋白胆固醇水平低（P＜0.05）。结论:合并代谢综合征的甲状腺结节患者恶性可能性更高，且在肿瘤直径、肿瘤位置、癌灶数量方面较未合并代谢综合征者表现出更严重的倾向，提示代谢综合征可能是影响甲状腺恶性肿瘤严重程度的危险因素。     

Follicular and Hurthle cell tumors of the thyroid gland. Possibilities of preoperative differential diagnosis

Changes suspicious for malignancy were detected in 127 patients who, according to scintigraphic examination of the thyroid, had "cold" nodules. As a consequence, all the patients were operated on and fine-needle aspiration findings were compared with the histological results. Thyroid cancer was identified in 18.9%. No differences in age between cases of benign, malignant follicular and Hurthle cell tumors were reported. Mean nodule size in patients with follicular and Hurthle cell adenoma (2.5 +/- 1.21 cm) differed from that in patients with thyroid cancer (3.35 +/- 1.86, p < 0.001). No differences in nodule size were observed in cases of micro-macrofollicular colloid goiter and thyroid cancer. The frequency of the latter was higher in Hurthle cell tumor (10 out of 23, 43.58%) than in thyroid tumor (14 out of 104, 13.56%), p = 0.002. Risk for thyroid cancer detection was higher in patients revealing nuclear atypia (10 out of 14 thyroid cancer patients, 71.4%) as compared with as low as 20 out of 79 adenoma patients, 25.32% (p = 0.03).     

血清促甲状腺素水平与甲状腺癌发病的相关性

目的 观察血清促甲状腺素(TSH)水平与甲状腺癌发病的关系.方法 回顾性分析330例(恶性99例,良性231例)行甲状腺手术的甲状腺疾病患者的血清TSH水平、性别、年龄、肿瘤类型、结节个数,并探讨其与甲状腺癌发生之间的关系.结果 在年龄＜20岁和≥70岁的患者中,甲状腺癌所占的比例分别为63.0％和58.3％,明显高于60 ～ 69岁组(23.3％,均P＜0.05).在81例男性患者中,甲状腺癌所占的比例为43.2％,明显高于女性患者(25.7％,P=0.003).在112例单结节患者中,甲状腺癌所占的比例为42.0％,明显高于多结节患者(23.9％,P＜0.001).在TSH＜ 0.28mIU/L组和≥4.20 mIU/L组患者中,甲状腺癌所占的比例分别为54.6％和50.0％,均明显高于0.28～1.44 mIU/L组(16.1％,均P＜0.05);在正常TSH范围内,甲状腺癌所占与的比例随TSH水平的升高而升高(P ＜0.001).血清TSH水平高(OR=1.465,P=0.014)、男性(OR=1.964,P=0.016)以及单个甲状腺结节( OR=2.090,P=0.006)均为发生甲状腺癌的独立危险因素.结论 血清TSH水平高、男性、单个甲状腺结节者患甲状腺癌的风险高.     

47例食管癌伴发甲状腺病变的临床病理分析

目的了解食管癌伴发甲状腺病变的临床病理特点。方法从活检库中筛选同时进行食管癌根治术和甲状腺结节切除术的病例,并观察食管癌伴发甲状腺病变的情况。结果 5 158例食管癌根治术患者中,同时切除部分甲状腺病变者47例,病理结果示,结节性甲状腺肿29例,甲状腺腺瘤5例,桥本氏甲状腺炎2例,正常甲状腺组织7例,甲状腺乳头状癌2例,甲状腺鳞癌2例。2例甲状腺鳞癌均为食管胸上段鳞癌伴发,并且分别伴有结节性甲状腺肿和桥本氏甲状腺炎。2例甲状腺乳头状癌均为食管胸中段癌伴发。不同部位食管癌合并甲状腺病变的概率由上至下逐渐减小,差异有统计学意义(P<0.05)。胸上段食管癌伴发甲状腺鳞癌概率高于胸中段和胸下段食管癌(P<0.05)。结论食管癌发生甲状腺转移罕见,甲状腺慢性疾病的基础可能是导致转移性鳞癌的一个重要因素。