巨大地方性甲状腺肿的手术治疗(附105例报道)

目的:总结巨大地方性甲状腺肿手术治疗经验。方法:回顾性分析105例巨大甲状腺肿的临床资料。结果:所有病人均经手术治疗,癌变3例实施甲状腺全切术,其余皆实施甲状腺次全切除术。术后病理诊断为:结节性甲状腺肿97例,其中3例癌变,6例继发性甲状腺功能亢进;胸骨后甲状腺肿12例;甲状腺腺瘤8例。随访1年,3例喉返神经损伤在3个月内恢复,甲状腺癌及甲状腺肿病人无复发。结论:巨大地方性甲状腺肿的适宜治疗方法为手术。选择合适的麻醉方法,小心处理甲状腺主要血管,避免喉返神经损伤,必要时行气管切开是治疗成功的关键。     

Clinicopathological correlation of serum TSH in patients with thyroid nodule

Thyroid nodules and goitre are common. Carcinoma occurs in 5% of thyroid nodules. Early detection and treatment is beneficial to prolonged survival. Higher thyroid stimulating hormone (TSH) level in patient with thyroid nodule is associated with greater risk of differentiated thyroid carcinoma. To assess relationship of TSH with thyroid carcinoma in nodular goitre and usefulness of this marker in predicting likelihood of thyroid malignancy, a study was undertaken among patients with nodular goitre enrolled prospectively during the period 2007 to 2009. Clinically thyroid nodules, confirmed by high resolution USG underwent serum TSH estimation and FNAC of the the nodules. Finally outcome of histopathological examination of resected thyroid specimen were analysed. Overall 33 patients with thyroid nodules were included in this study. Fifteen patients belonged to age group of 31 to 40 years, 13 belonged to 21 to 30 years; 29 were women, 4 were men. Majority of nodules were in right lobe and firm or hard. Fifteen nodules were > 4cm in size. FNAC showed colloid goitre in 24 patients, 7 patients had papillary carcinoma, 2 patients had follicular nodule. Final histopathological report showed 9 papillary carcinoma, 1 medullary carcinoma, 1 follicular carcinoma, 2 follicular adenoma and rest being colloid goitre. Mean TSH value for colloid goitre was 1.8987 mlU/l, for papillary carcinoma it was 2.2400 mlU/l, for follicular carcinoma it was 2.8900 mlU/l, for medullat carcinoma it was 0.8500 mlU/l and for follicular adenoma it was 4.4200 mlU/l. In differentiated thyroid carcinoma TSH value is raised more than in colloid goitre (p = 0.687). Incidence of malignancy in nodular goitre was 30% (11 carcinoma out of 33) in this study. Incidence of malignancy in nodular goitre is rising. Firm to hard nodules, male sex, 3-4 cm sized nodules are mainly susceptible. There is an obvious trend towards cancer risk with higher TSH value. TSH may, therefore, be used as a supportive screening test to predict malignancy in patients with thyroid nodule.     

Follicular neoplasm involving one lobe of thyroid: is hemithyroidectomy the adequate initial procedure?

Aim

Ultrasound-guided fine-needle aspiration cytology (FNAC), intraoperative frozen section, elastography and molecular markers have been tried to predict malignancy in indeterminate thyroid lesions. However, only histopathological evidence of capsular and vascular invasion can confirm malignancy. The aim of this study is to determine the effectiveness of hemithyroidectomy (HT) as an adequate surgical intervention in patients having cytologically proven follicular neoplasm limited to one lobe of the thyroid in a resource-limited country like India.

Materials and methods

A retrospective study was conducted. The data of all patients operated for FNAC-proven follicular neoplasm (2008–2011) were analysed.

Results

A total of 123 cases had FNAC-proven follicular neoplasm. Fourteen were male and 109 female. Forty-six patients with multiple nodules involving both lobes (MNG) underwent total thyroidectomy (TT), whereas 77 who had solitary thyroid nodule (STN) underwent HT. Among patients who had HT (n = 77), histopathology revealed malignancy in 3.6 % (n = 3). Patients who needed completion thyroidectomy (CT) were older females (p = 0.02) with higher TSH levels (p = 0.0001), shorter duration of goitre (p = 0.01) and smaller nodules (p = 0.04).

Conclusions

Hemithyroidectomy is an adequate initial surgical procedure for FNAC-proven follicular neoplasm. The incidence of carcinoma is 3.9 %. Older subjects with high normal TSH are likely to have malignancy. Routine employment of intraoperative frozen section, elastography and molecular markers is not necessary if locally unavailable, since the incidence of malignancy in FNAC-proven follicular neoplasm is low.     

甲状腺微小癌的生物学特性与诊治方式

目的：探讨甲状腺微小癌的生物学特性与诊治方式。方法：回顾性分析36例甲状腺微小癌的临床及病理资料。结果：36例甲状腺微小癌均为术前拟诊结节性甲状腺肿、甲状腺瘤及甲状腺机能亢进等良性病变,经术中冰冻并术后石蜡切片确诊微小癌。28例术前诊断结节性甲状腺肿者,26例一侧TMC者,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,2例双侧微小癌行甲状腺全切除,2例甲状腺机能亢进者行患侧叶加峡部切除及对侧叶大部切除术。6例甲状腺腺瘤者行患侧腺叶加峡部切除。2例活检诊断淋巴结转移者行患侧中央区淋巴结清扫术。34例获得随访6个月～10年,均无瘤生存。结论：掌握甲状腺微小癌的生物学特点利于其诊断及治疗的选择,彩色多普勒超声检查是诊断甲状腺微小癌的重要手段,患侧甲状腺腺叶全切除加峡部切除和/或对侧腺叶次全切除术为主要术式,一般不作预防性颈清扫术。     

胸骨上入路完全腔镜下甲状腺手术的应用研究

目的 探讨胸骨上入路完全腔镜下甲状腺手术的安全性及技术要点.方法 于2002年10月到2009年12月对57例甲状腺良性病变施行胸骨上入路完全腔镜下甲状腺手术.其中结节性甲状腺肿30例,甲状腺腺瘤15例,甲状腺囊肿12例.结果 所有手术均获成功,手术时间为90～180min,无中转开放手术.术后无大出血、声音嘶哑、手足...     

腔镜下甲状腺良性疾病手术治疗的探讨

目的探讨经胸乳径路腔镜甲状腺良性疾病手术的临床应用价值。方法对24例应用腔镜行甲状腺手术患者的临床资料进行回顾性分析总结。结果23例顺利完成腔镜甲状腺手术,1例术中快速冰冻切片为甲状腺乳突状癌,中转开放手术。手术时间45～230min,平均121min。病理检查结果：甲状腺腺瘤2例,结节性甲状腺肿8例,结节性甲状腺肿囊性变13例,甲状腺乳头状癌1例．术后1例声音嘶哑,经治疗后3个月恢复。术中术后无大出血、抽搐、无皮下感染积液、脂肪液化,颈部美容满意率97．3％,一般2．7％,不满意0。结论经胸乳入路腔镜下行甲状腺手术切口远离颈部,胸壁切口微小,颈部无瘢痕,美容效果极佳,疗效可靠。     

甲状腺肿块149例手术治疗分析

目的探讨外科治疗的甲状腺疾病的构成,手术方法及总结治疗效果。方法回顾性分析2004年8月～2009年11月我院149例甲状腺手术病人临床资料。该组以结节性甲状腺肿80例,甲状腺腺瘤55例,甲亢7例,桥本氏甲状腺炎1例,甲状腺癌6例;良性疾病以患侧腺叶次全切除术为主,甲亢行双侧次全切除术,甲状腺癌以根治性手术为主;采用颈丛麻醉及全身麻醉。结果手术后并发症,发生暂时性声音嘶哑6例,甲状腺功能低下2例。149例手术病人无死亡、切口感染、术后大出血、术后抽搐、窒息及气管切开等。结论该组甲状腺疾病以结节性甲状腺肿、甲状腺瘤为主,患侧腺叶次全切除术为主要术式,但应根据病变性质、部位、大小而采取个体化方案,而术前对甲状腺结节性质的正确评估,充分的术前准备,手术操作细致及注重手术细节是提高手术效果的重要因素。     

1977例甲状腺手术临床分析

目的：总结甲状腺疾病手术治疗的临床经验。方法：收集近9年来经手术治疗的甲状腺病例的临床资料,统计经手术治疗的甲状腺疾病的分类,各类手术并发症的发生率。结果：9年来甲状腺手术共1977例。男女性别比为1：5．68,其中包括甲状腺肿789例,甲亢755例,甲状腺瘤353例,甲状腺癌19例,甲状腺炎4例,甲状腺再次手术57例。共出现各种手术并发症105例,发生率为5．31％,无手术死亡病例。结论;接受甲状腺手术治疗的患者以女性占多数,现阶段各种甲状腺疾病仍以手术治疗为主,手术治疗也是安全有效的。     

桥本病合并甲状腺结节的诊断和治疗

目的总结桥本病合并甲状腺结节的诊断和治疗的经验。方法分析该院1991年1月～2006年1月外科手术治疗的31例桥本病合并甲状腺结节的临床资料。结果31例均并发有甲状腺结节,其中合并甲状腺癌4例(12.90%),甲状腺腺瘤2例(6.45%),结节性甲状腺肿6例(19.35%),甲状腺功能亢进1例(3.22%),其余均为淋巴滤泡样结节。术前29例诊断为其他的甲状腺疾病,误诊率为93.5%。均行手术治疗,手术中根据快速病理检查采取了不同范围的手术方式。26例获得随访,随访率为83.87%;术后发生甲状腺功能减退1例。结论合并其他甲状腺疾病的桥本病临床上诊断困难,易误诊,对于并发甲状腺结节的桥本病应考虑手术治疗,手术中应尽量保留正常的甲状腺组织,以防止甲状腺功能减低。     

甲状腺功能亢进症和甲状腺癌并存10例

本文报告甲状腺功能亢进症合并甲状腺癌10例,占同期手术治疗甲亢病人的2.1%(10/475).男1例,女9例,25～35岁者7例.1例行甲状腺近全切除术,9例行甲状腺大部切除术.全组随访半年至8年均无复发及远处转移.     

腔镜甲状腺次全切除术治疗结节性甲状腺肿72例

目的探讨腔镜下甲状腺叶次全切除术治疗结节性甲状腺肿的方法及临床意义。方法2004年6月至2009年12月,西南医院乳腺中心共完成216例腔镜甲状腺手术中,采用腺叶次全切除术治疗结节性甲状腺肿72例,左侧22例,右侧31例,双侧19例。单发结节41例,多发结节31例,共113个结节,结节直径0．4～6．3cm,平均2．8cm。结果行双侧甲状腺次全切19例,手术时间80～150min,平均97min;单侧次全切53例,手术时间25～12min,平均65min。术中出血5～120ml,平均45ml。行颈丛加局麻68例,耐受良好66例（97％）,全麻4例。术后出现暂时性声音嘶哑2例,穿刺道内出血2例。随访3～5年,医患双方对美容效果均非常满意。1例术后半年复查出现单侧结节复发,复发率为1．4％。结论经前胸壁入路或经乳房途径腔镜下甲状腺叶次全切除是治疗结节性甲状腺肿的有效方法,局麻加颈丛在大多数病例安全可靠,游离甲状腺时避免直接抓夹甲状腺组织或肿块,采用钝性推、挡法及超声刀的正确使用可有效减少术中出血,提高安全性。     

甲状腺弥漫性疾病的彩色多普勒超声诊断价值

目的:探讨甲状腺弥漫性疾病的超声显像特点及其诊断价值。方法:应用超声诊断技术对85例甲状腺弥漫性疾病患者及60例甲状腺正常人群进行检查,分析甲状腺弥漫性疾病的声像图特点和诊断依据。结果:异常组85例弥漫性甲状腺患者中结节性甲状腺肿28例,单纯甲状腺肿10例,桥本甲状腺炎19例,Graves病16例,亚急性甲状腺炎12例。结论:超声检查可以较准确的诊断甲状腺弥漫性疾病,为临床诊断及合理用药提供依据。     

结节性甲状腺肿合并偶发乳头状癌临床分析

Objective: To investigate the clinical features and principles for the diagnosis and treatment of incidental papillary carcinoma (IPC) in goiter. Methods: Ninety-two patients with different thyroid carcinoma in nodular goiter admitted from July 2008 to December 2013 were retrospectively analyzed. Results: Overall, Ninety-two IPCs were recorded (male 15,female 77). The largest benign nodules had an average diameter(2.37±0.68)cm , the diameter of IPC ranged from 0.1～1.0 cm and the average diameter was (0.43±0.27)cm. Ninety-one cases(98.9%) were unifocal, and 1 case was unilateral multifocal(2 centers), 92 cases(100%) took L-T₄ post operation for long time, 80 cases were followed up for 7～72 months and no recurrence or metastasis was found. Conclusion: The overall incidence of IPC in nodular goiter was 7.2%. For IPC patients who are considered nodular goiter receiving lobectomy or near-total thyroidectomy before operation, reoperation is unnecessary. However, L-T₄ is regular drug for post-operation patients. Regular following-up is also essential.     

单侧甲状腺结节216例的临床分析

目的探讨甲状腺腺叶切除术治疗单侧甲状腺结节的效果.方法回顾性分析216例单侧甲状腺结节病人的临床资料.结果216例患者施行甲状腺腺叶切除或腺叶加峡部切除术.术后病理检查诊断为滤泡状和乳头状囊性腺瘤178例,结节性甲状腺肿30例,甲状腺癌8例.术后随访3月～3a,无1例复发,无甲状腺功能减退症状发生,临床疗效满意.结论单侧甲状腺结节常规施行腺叶切除术是一种安全有效的治疗方式.     

甲状腺再手术相关因素研究

为探讨甲状腺再手术指征、危险性及其相关因素,作者对297例甲状腺再手术患者进行了总结分析.结果显示,甲状腺再手术主要原因是术前对肿块性质缺乏准确诊断,仅行局部切除,术后病检证实为恶性(142例);其次为良性肿瘤术后复发(96例);142例疑癌残留患者中,再手术病检阳性116例(81.7%);良性肿瘤术后较长时间(>10年),患侧出现肿块及原发性甲状腺机能亢进术后出现肿块,再手术恶变率分别为61.6%(16/26)和75%(3/4);本组喉返神经损伤(永久性)11例,暂时性甲状旁腺功能低下5例,胸导管及食道损伤各1例,甲状腺功能低下242例.提示甲状腺再手术适用于甲状腺良、恶性疾病,因其较高的术后并发症的存在,首次手术时应考虑周全,尽量设法避免再手术.     

经胸前径路内镜甲状腺手术的临床应用

目的探讨经胸入路微型腹腔镜甲状腺切除术较传统切开手术的优势。方法2006年4月~2009年10月,行甲状腺良性肿物手术120例,其中腔镜手术59例,传统开放手术61例。比较两种术式的手术时间、出血量、术后疼痛评分、切口美容评分、并发症、引流量、住院时间、住院费用、复发率。结果两组手术均获成功,无出血、声嘶、低血钙等并发症。腔镜组出现声音嘶哑1例,出现胸骨前皮下血肿2例。传统组出现声音嘶哑2例;出现低钙血症1例。腔镜组与开放组相比,失血量少（P=0.000）,疼痛轻（P=0.000）,切口美容满意度高（P=0.000）,引流量少（P=0.000）,住院时间短（P=0.000）,但手术时间长（P=0.000）。并发症发生率、复发率、住院费用差异无统计学意义（P〉0.05）。术后随访1~18个月,平均10个月,传统组复发2例。结论经胸前径路内镜甲状腺手术兼有美容与微创两大优势,值得在临床上推广。     

桥本氏甲状腺炎合并结节的外科治疗

目的:探讨合并结节的桥本氏甲状腺炎临床发病关系及其诊断、治疗和预后。方法:收集我院2003～2007年外科手术治疗并经病理证实合并甲状腺结节的桥本氏甲状腺炎224例病例资料及随访资料进行回顾性分析,分析其临床特征(肿瘤大小、手术方法),探讨其手术适应证,手术范围及术后发生甲状腺功能减低的原因。结果:全组病例均并发甲状腺结节,其中甲状腺癌24例,甲状腺腺瘤17例,甲状腺机能亢进22例,结节性甲状腺肿121例,40例为单纯桥本氏甲状腺炎。224例均行外科手术治疗,术中行快速病理检查,根据病检行不同范围的甲状腺切除术,术后全组病例服用优甲乐,随访6个月～4年,61%的病例复查甲状腺功能正常,6个月后停药。并发甲癌者终生服药外,有37例出现甲状腺功能减退,长期服药。结论:对于合并甲状腺结节的桥本氏甲状腺炎应考虑手术治疗。桥本氏甲状腺炎合并甲状腺结节术前常规测甲状腺功能、彩色多普勒B超检查,CT检查及同位素扫描,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。     

原发性甲状腺恶性淋巴瘤10例临床分析

目的 总结原发性甲状腺恶性淋巴瘤(PTL)的诊断和治疗经验.方法 10 例PLT患者采用甲状腺全切除术、CHOP方案(环磷酰胺,阿霉素,长春新碱)化疗及术后放疗,回顾性分析其临床特点及疗效.结果 术前9例患者被误诊为甲状腺癌,1例误诊为结节性甲状腺肿.10例患者均行甲状腺全切除术,4例颈部淋巴结有转移的患者行甲状腺全切...     

桥本氏病的手术治疗（附30例临床分析）

目的：研究桥本氏病的诊断和手术治疗的适应证及其疗效。方法：本对30例手术治疗的桥本氏病的诊断和治疗进行了回顾性分析。结果：共有13例作TGA和TMA测定，TGA和TGM均为阳性6例，均为弱阳性5例，TGA阳性及TGM弱阳性1例，均为阴性1例。甲状腺B超共做26例，诊为结节性甲状腺肿13例，甲状腺腺瘤8例，甲亢2例，甲状腺癌2例，桥本氏病1例。术前诊断结节性甲状腺肿13例，甲状腺腺瘤7例，甲状腺癌3例，甲亢1例，慢性甲状腺炎6例。术后病理均为桥本氏病，合并其他甲状腺疾病26．7％。其中行双侧次全切10例，单侧次全切11例，单侧部分切除活检6例，峡部切除3例。30例病人术后均痊愈出院。术后远期出现甲低2例，无其他并发症发生。结论：桥本氏病诊断有赖于TGA、TGM、B超、穿刺细胞学或手术病理学检查。因桥本氏病合并其他甲状腺疾病比例较高，误诊率高，为了确诊和治疗，有选择的对一些病人施行手术，是安全而必要的。在甲状腺手术中施行冰冻活检应视为常规，可明确诊断及指导术式选择。     

Role of surgery in the management of Graves' disease.

Seventy-two patients, 50 women and 22 men, were operated on for Graves' disease. Their median age was 35 years. The indications for surgery included patients with large goitre, relapse after antithyroid drug (ATD) therapy, allergic reactions to ATD, non-compliance and finally an associated nodule with suspicion of carcinoma. Patients were rendered euthyroid with ATD before surgery and were pretreated with Lugol's iodine. Standard subtotal thyroidectomy was performed in 64 patients, total thyroidectomy in 7 patients, and one patient underwent a completion thyroidectomy after an initial subtotal thyroidectomy. The weight of the thyroid remnant on either side was estimated emperically between 3 g and 5 g. There was no postoperative death or thyrotoxic crisis. There was no case of permanent recurrent laryngeal nerve damage or hypoparathyroidism. Eight patients (11.1%) had temporary unilateral vocal cord palsy and 4 patients (5.5%) had temporary hypocalcemia. One patient (1.4%) developed recurrent hyperthyroidism. Postoperative transient hypothyroidism developed in 87.5% cases, all within the first postoperative year. The functional results at 2 years were as follows: Out of 47 cases followed 31 patients (65.9%) became euthyroid while 15 (31.9%) were still hypothyroid and requited long term substitutive treatment. Ophthalmopathy worsened in only one patient. Thyroidectomy has reasonable role in the management of Graves' disease, because the patients have had their diseases rapidly terminated, were hospitalised for an average period of only 3.5 days and have had no permanent functional insult except for hypothyroidism.