99mTc-N(NOEt)2鼻咽癌动物模型显像的实验研究

目的:探讨99m锝-氮-二(N-乙基-N-乙氧基二硫代氨基甲酸盐)[99mTc-N(NOEt)2]用于小鼠鼻咽癌肿瘤模型显像中的可行性。方法:采用正常昆明小鼠进行99mTc-N(NOEt)2生物分布实验。皮下种植CNE细胞制作BALb/c裸鼠鼻咽癌肿瘤模型。采用99mTc-N(NOEt)2与99m锝-六(2-甲氧基-2-异丁基异腈)(99mTc-MIBI)SPECT肿瘤模型显像,通过感兴趣区技术记录不同时间肿瘤/非肿瘤组织显像剂分布比值(T/N),对比评估99mTc-N(NOEt)2与99mTc-MIBI在鼻咽癌肿瘤模型显像中的价值。结果:生物分布结果提示99mTc-N(NOEt)2多分布于肝脏、肾脏、肺、脾脏及心脏。99mTc-N(NOEt)2和99mTc-MIBI显像均可以显示鼻咽癌模型肿瘤。注射显像剂后30min时99mTc-N(NOEt)2与99mTc-MIBI在肿瘤部位的T/N差异无统计学意义。99mTc-N(NOEt)2在鼻咽癌肿瘤的T/N于120min达到最高(3.4±0.4),显著高于99mTc-MIBI(2.5±0.3),并且可以清晰显示肿瘤组织。结论:99mTc-N(NOEt)2显像可用于裸鼠鼻咽癌模型的诊断,注射后120min时肿瘤显像最佳,优于99mTc-MIBI。99mTc-N(NOEt)2有望成为一种替代99mTc-MIBI的鼻咽癌显像剂。     

核素显像鉴别颈前区包块来源的临床价值

目的:回顾分析甲状腺核素显像在颈前区包块鉴别诊断中的临床价值。方法:对69例耳鼻咽喉科门诊首诊发现颈前区来源不明包块的患者行过锝酸盐(99mTcO4-)显像,根据结果选择行99mTc-甲氧基异丁基异腈(99mTc-MIBI)肿瘤阳性显像和甲状腺灌注显像。显像结果结合随访及病理诊断结果进行分析。结果:69例中33例(47.8%)包块位于甲状腺内,36例(52.2%)包块位于甲状腺外。甲状腺包块中发现亚急性甲状腺炎12例,2例临床诊断为甲状舌管囊肿者发现为异位甲状腺;甲状腺外包块中甲状舌管囊肿27例。结论:甲状腺包块的99mTcO4-、99mTc-MIBI阳性显像及血流灌注显像对于鉴别诊断颈前区病变是否来源于甲状腺及甲状舌管囊肿与异位甲状腺的鉴别具有良好的应用价值。     

甲状腺嗜酸细胞肿瘤28例诊治分析

目的 探讨甲状腺嗜酸细胞肿瘤的临床特点和治疗效果.方法 回顾性分析天津医科大学附属肿瘤医院头颈外科2001-2009年收治的28例甲状腺嗜酸细胞肿瘤患者临床资料.结果 患者中男6例,女22例;年龄18～72岁,中位年龄46.5岁.22例临床表现为甲状腺单发结节或肿块,6例表现为甲状腺多发结节.行单侧甲状腺腺叶切除11例,单侧甲状腺腺叶+峡部切除11例,甲状腺近全切除术4例,2例行腺叶+峡部切除及颈清扫术.术后病理:甲状腺嗜酸细胞腺瘤22例,嗜酸细胞癌6例,其中1例有颈淋巴转移.21例良性患者获得随访,随访时间6个月至7.5年,中位随访45个月,均未发现肿瘤复发;6例恶性患者均获得随访,随访时间3～8年,中位随访54个月,均未发现肿瘤复发或转移.结论 甲状腺嗜酸细胞肿瘤诊断依赖于病理学,部分病例有恶性可能,冰冻诊断有一定困难.手术是治疗嗜酸细胞肿瘤的有效手段.左旋甲状腺素片可起到抑制促甲状腺激素分泌的作用.     

超声引导下热消融技术尚不适用于甲状腺癌及甲状腺滤泡性肿瘤治疗

甲状腺结节为临床常见疾病,大多数良性结节可观察随访,无需特殊治疗,即使考虑治疗外科手术是常规考虑的主要治疗方法[1].近些年,随着微创技术的发展,超声引导下经皮热消融术如超声引导下经皮射频消融术(radiofrequency ablation,RFA)、经皮微波消融术(microwave ablation,MWA)及经皮激光消融术(laser ablation,LA)等逐渐应用于甲状腺良性结节的治疗[2-3].目前,RFA已被认为是良性甲状腺结节非手术治疗的一种有效和安全的选择[4-5],由于热消融技术可以有效地减少甲状腺结节体积、缓解结节相关症状并且避免手术创伤,国际上多家临床中心将其应用于良性实性结节的治疗.     

18F-脱氧葡萄糖正电子发射断层扫描诊断早期甲状腺肿瘤

2005年1月～2006年8月,我们在健康体检中采用18F-脱氧葡萄糖(18fluorine fluorodeoxyglucose,18F-FDG)正电子发射计算机断层显像(positron-emission tomography,PET)发现23例甲状腺有高代谢结节灶,并与术后的病理检查进行比较,借以探讨该检查对甲状腺恶性肿瘤早期诊断作用,报道如下.     

鼻咽纤维血管瘤的^99mTc-MIBI显像

目的 :为鼻咽纤维血管瘤寻找无创而有效的术前定性诊断方法。方法 :采用99mTc MIBI对 3例鼻咽纤维血管瘤患者进行头颈部亲肿瘤显像检查。结果 :3例鼻咽纤维血管瘤的早期显像均呈弱阳性 ,延迟显像均表现为放射性分布缺损 ,与恶性肿瘤的阳性显像结果及良性肿瘤的阴性显像结果有明显区别。结论 :99mTc MIBI头颈部亲肿瘤显像对患者无创 ,其显像结果具有一定的特征 ,可作为鼻咽纤维血管瘤术前无创而有效的定性诊断方法。     

单侧甲状腺微小乳头状癌合并对侧甲状腺小结节患者的临床分析

目的 总结单侧甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)合并对侧甲状腺小结节(最大径＜1 cm)患者的临床特点及处理方法.方法 回顾性分析253例单侧PTMC对侧腺叶合并有术前B超诊断为良性小结节患者的临床资料.253例患者均行甲状腺一侧腺叶切除、对侧近全切除或全切除术.对患者相关临床特征采用x2检验进行单因素分析,采用Logistic回归进行多因素分析.结果 53例(20.9％)患者对侧小结节术后病理诊断为PTMC,其余200例(79.1％)为良性结节.单因素分析发现,对侧结节PTMC发生与合并桥本甲状腺炎和一侧多发癌灶有关(x2=24.834,x2=5.182,P值均＜0.05),与年龄、性别、病灶大小、被膜侵犯、淋巴转移、结节数量及甲状腺球蛋白水平无关.多因素分析显示只有一侧多发癌灶是对侧结节PTMC发生的独立危险因素(OR=5.352,P＜0.05).结论 甲状腺多发小结节患者若一侧为多灶性的PTMC,对侧小结节发生B超难以分辨的PTMC的概率较高,宜采取甲状腺全切除术的治疗策略.     

强化手术技能和规范诊疗是提高甲状腺癌疗效的根本

随着经济的发展、环境改变,检查普及和技术的提高,甲状腺结节的发现率呈明显的逐年上升的趋势,甲状腺癌的发病率也随之升高.各体检中心不仅关注心肺和腹部重要脏器的检查,颈部的小器官甲状腺也经常被列为常规检查项目,超声设备的改进和诊断技术的提高,使2～3mm以上的小的甲状腺结节都能被超声检出,导致甲状腺结节的发生率大幅度提高.据报道,成人甲状腺B超检查结果显示,约有50％检出结节[1].门诊以甲状腺结节就诊的患者大量增加,收治甲状腺肿瘤的病房也人满为患,很多地市级医院都成立了甲状腺外科或甲乳科.     

超声附加绘图定位甲状腺微小结节的临床应用

目的 探讨超声附加绘图定位甲状腺微小结节在临床中的应用价值.方法 选取88例(137个结节)甲状腺微小结节患者,按照就诊次序,依次分为两组:绘图组46例(68个结节),对照组42例(69个结节),进行对照研究,纳入标准为结节直径≤1 cm,两组术前行常规超声检查,绘图组附加绘图定位微小结节,附加绘图方法为甲状腺纵切面六分法和甲状腺横切面四分法,对照组未行绘图.比较两组患者在术中医生能否准确依据超声检查提供的绘图找到结节以及术后复查结节残留的情况.结果 两组超声诊断准确率为81.8％ (69/88)；术中绘图组结节全部准确找到,对照组4例(4个结节)未找到；术后3个月复查超声,绘图组未发现结节残留,对照组发现4个超声可疑恶性结节残留.结论 超声检查附加绘图,术前精准定位甲状腺微小结节,指导临床医师术中准确、快速找到结节,制定合理化手术方案,以期达到治愈肿瘤的目的.     

64排CT增强扫描在甲状腺结节良恶性诊断中的应用

目的 探讨甲状腺结节良、恶性诊断中64排CT增强扫描的应用及特异性和灵敏度.方法 选取2016年4月～2020年8月金湖县人民医院收治的128例甲状腺结节患者,对患者进行64排CT增强扫描,与病理诊断结果进行比较.结果 128例甲状腺结节患者,恶性患者56例(43.8％);良性患者72例(56.2％),其中结节性甲状腺...     

人鼻咽癌CNE细胞摄取99mTcN(NOEt)2与99mTc-MIBI动力学对比研究

目的：研究^99mTc-氮二{（N-乙基-N-乙氧基二硫代氨基甲酸盐[N（NOEt）2]）和^99mTc甲氧基异丁基异腈（MIBI）在人鼻咽癌CNE细胞中的摄取动力学。方法：用放射性核素示踪技术研究人鼻咽癌CNE细胞在37℃和22℃时对^99mTcN（NOEt）2和^99mTc-MIBI的摄取动力学规律。结果：37℃和22℃时CNE细胞对^99mTcN（NOEt）2的摄取差异无统计学意义,^99mTcMIBI摄取则呈温度依赖性。37℃时CNE细胞对^99mTcN（NOEt）z摄取峰值为43．15％,^99mTc-MIBI为11．08％（P〈0．01）;5min时CNE细胞摄取^99mTcN（NOEt）2为峰值的63％．^99mTc-MIBI为48％（P〈0．05）;60min时^99mTcN（NOEt）2在CNE细胞中的滞留率为63．92％,^99mTc-MIBI为53．97％（P〈0．05）。结论：^99mTcN（NOEt）2可能较^99mTc-MIBI更适用于鼻咽癌显像,具有潜在的临床应用价值。     

Follicular Thyroid Carcinoma Presenting as Bilateral Cheek Masses

Mandibular metastasis of thyroid carcinoma is extremely rare. We present the case of a 46-year-old woman who had bilateral huge cheek masses that had grown rapidly over several years. Intra-oral mucosal tissue biopsy and imaging work-up including computed tomography scan and magnetic resonance imaging were performed and the initial diagnosis was presumed to be central giant cell granuloma. Incidentally detected thyroid lesions were studied with ultra-sonography guided fine needle aspiration and diagnosed as simple benign nodules. Due to continuous oral bleeding and the locally destructive feature of the lesions, we decided to excise the mass surgically. To avoid functional deficit, a stepwise approach was performed: Firstly, the larger left mass was excised and the mandible was reconstructed with a fibular free flap. The final pathologic diagnosis was follicular thyroid cancer. Postoperative I-131 thyroid scan and whole body positron-emissions-tomography were performed. Right side mass was revealed as a thyroid malignancy. Multiple bony metastases were detected. Since further radioactive iodine therapy was required, additional total thyroidectomy and right side mandibulectomy with fibular free flap reconstruction was performed. The patient also underwent high dose radioactive iodine therapy and palliative extra-beam radiotherapy for the metastatic lumbar lesion. Follicular thyroid carcinoma should be considered as a differential diagnosis for mandibular mass lesions.     

放射性纳米示踪剂在甲状腺颈部淋巴结中的实验研究

目的 通过将不同粒径(平均直径约为50 nm、80 nm和100 nm)和剂量(0.01 ml和0.02 ml)的放射性纳米示踪剂(99m锝-三硫化二锑,99mTc-Sb2S3)应用于兔甲状腺中,观察其在兔颈部淋巴结中的运行情况,为甲状腺癌患者前哨淋巴结活检选择较佳的放射性纳米示踪剂提供实验依据.方法 将30只新西兰成年雄兔(共60侧甲状腺),采用单纯随机抽样方法将其分为99mTc-Sb2S3粒径分别为50 nm注入0.01 ml、50 nm注入0.02 ml、80 nm注入0.01 ml、80 nm注入0.02 ml、100 nm注入0.01 ml和100 nm注入0.02 ml的6组,每组5只新西兰兔(共计10侧甲状腺),观察每组检出的淋巴结枚数,淋巴结开始具有放射性的时间,淋巴结放射性最强的时间和淋巴结的放射性持续时间.结果 6组实验中每侧颈部检出的淋巴结在1～3枚之间,共86枚,主要分布在Ⅵ区,为65枚(75.6%).50 nm粒径的99mTc-Sb2S3比80 nm和100 nm粒径的99mTc-Sb2S3在淋巴结开始具有放射性和具有最强放射性的时间均早,差异有统计学意义(P值均<0.05).相同纳米粒径的99mTc-Sb2S3,0.01 ml组和0.02 ml组在淋巴结检出枚数、淋巴结开始具有放射性时间、淋巴结具有最强放射性时间和淋巴结放射性持续时间上差异均无统计学意义(P值均>0.05).每组淋巴结在30 min内均可持续观察到放射性.结论 50 nm粒径的放射性纳米示踪剂(99mTc-Sb2S3)在淋巴管中移动速度较快,淋巴结摄取率高,并且淋巴结的放射性可以持续至少30 min,可能是进行免甲状腺颈部淋巴结检测较佳的粒径,99mTc-Sb2S3的剂量选择0.01 ml和0.02 ml均可.     

舌异位甲状腺的诊治

目的　探讨舌异位甲状腺临床特点、诊断及治疗。方法　回顾性分析6例舌异位甲状腺患者临床资料,分析其临床特征、影像学特点、治疗方案及预后。结果　6例舌异位甲状腺经Tc-99m甲状腺静态显像确诊,均位于舌根部。1例甲状腺素替代治疗,1例未行任何治疗。3例行舌根异位甲状腺转位术,术后均口服左旋甲状腺素片,咽部异物感和睡眠打鼾症状消失。1例舌根异位甲状腺乳头状癌行支撑喉镜下舌根肿物切除术,失访。结论　甲状腺静态显像对舌异位甲状腺诊断具有特异性。其手术适应证为异位甲状腺致气道阻塞、睡眠打鼾及咽部异物感等症状明显者,肿物出血、囊性变及癌变。治疗原则是尽量保留甲状腺功能,综合运用手术、甲状腺激素替代及碘放疗等方法改善症状、预防及治疗甲状腺功能减退。     

Controversies in the Management of Thyroid Nodule

Few subjects in surgery have generated as much controversy as the management of thyroid nodule. The controversial issues include classification and histology, diagnostic evaluation including needle biopsy, indications for surgery, management of incidentalomas of the thyroid, the role of frozen section, extent of thyroidectomy, management of neck nodes, the role of suppressive therapy, the use of radioactive iodine, and appropriate follow‐up. The two major issues in relation to the controversies are diagnostic workup and extent of thyroidectomy. Whenever the issue related to extent of thyroidectomy is discussed, there are two strong groups believing in total thyroidectomy or less than total thyroidectomy. This has generated considerable debate and panel discussions, and this article reviews this on‐going debate.     

小切口甲状腺切除术对甲状腺结节患者恢复情况及甲状腺激素水平的影响

目的探讨小切口甲状腺切除术对甲状腺结节患者恢复情况及甲状腺激素水平的影响。方法选取2017年1月至2019年12月收治的60例甲状腺结节患者进行观察,均接受小切口甲状腺切除术,观察甲状腺结节患者恢复情况,并检测观察甲状腺激素水平变化。结果 60例甲状腺结节患者治疗总有效率为96.67 %,并发症发生率为3.33 %。术后7d患者游离三碘甲状腺原氨酸(FT3)及游离甲状腺素(FT4)等甲状腺激素水平较术前明显降低(P<0.05),总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)较术前无明显变化(P>0.05),术后3个月甲状腺激素水平较术前无明显变化(P>0.05)。结论小切口甲状腺切除术治疗甲状腺结节手术及术后恢复效果好,术后并发症少,且不会对甲状腺激素水平造成明显影响,值得推广。     

Analysis of thyroid dysfunction in patients with sudden sensorineural hearing loss

BackgroundSudden sensorineural hearing loss (SSHL) refers to the sudden occurrence of unexplained sensorineural hearing loss. The present study showed that different systemic diseases had different influence on the occurrence and hearing outcome of SSHL. Thyroid hormone is one of the important factors for the development of fetal ear and auditory function. However, the distribution of thyroid dysfunction in SSHL patients and the effect of thyroid dysfunction on the occurrence and hearing outcome of SSHL has not been studied.MethodsIn this study, a retrospective analysis had been done in 676 patients with SSHL. We had described the distribution of thyroid function in patients with SSHL in detail, and by the statistical method, analyzed the relationship between the hearing outcome and thyroid dysfunction, respectively.ResultsIn all patients, 24.41% (165/676) had abnormal thyroid function testing results. The onset age of SSHL in FT3 abnormal group (including low and high group) was younger than that in normal FT3 group. Recovery group had more patients with lower-than-normal T3 level as compared to non-recovery patients. Significant associations between T3 levels and hearing outcome were observed in the subgroup with longer time elapse between symptom onset and treatment (≥14 d).ConclusionThe incidence of thyroid dysfunction in SSHL is significantly higher than in the general population. There was obvious relationship between T3 and FT3 item of thyroid dysfunction and the onset time and hearing outcome of SSHL, which indicated that T3 or FT3 indicator may be one of the affecting factors for the SSHL. Early screening and diagnosis of thyroid dysfunction, especial T3 level, may help to evaluate the prognosis in SSHL patients.     

喉额侧窗式切除术治疗侵及前联合的T1b期声门型喉癌疗效分析

目的 探讨喉额侧窗式切除术结合甲状软骨外膜瓣修复术治疗侵及前联合的T1b期声门型喉癌的疗效.方法 对确诊为前联合受侵的T1b期声门型喉癌患者22例,均行喉额侧窗式切除术结合甲状软骨外膜瓣修复术治疗;随访5年,观察患者术后呼吸功能、吞咽功能、发音功能、复发率及生存率.结果 所有患者手术均顺利完成,术后二周拔除气管套管,拔管率100％;无一例发生误咽;术后患者发声功能(G分级)较术前改善者为86.4％(19/22),与术前相同者为13.6％(3/22);肿瘤复发2例,1例为原位复发,1例为颈部淋巴结转移复发,复发率为9.1％(2/22);5年生存率为95.5％(21/22).结论 喉额侧窗式切除术结合甲状软骨外膜瓣修复术式适用于前联合受侵的T1b期声门型喉癌,该术式能相对完整地保留喉的骨架及生理功能,不易引起喉狭窄,且修复组织稳定,能有效改善发声质量.     

Primary squamous cell carcinoma of the thyroid associated with papillary thyroid carcinoma and Hashimoto's thyroiditis

IntroductionWe report the first case of squamous cell carcinoma (SCC) of the thyroid gland coexisting with papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis and discuss various theories concerning the histogenesis of SCC of the thyroid gland and the optimal treatment strategy.Case reportA 54-year-old woman presented with an anterior neck mass measuring 4 cm on clinical examination. Imaging showed a suspicious thyroid nodule invading the trachea. Total thyroidectomy with bilateral central lymph node resection was performed. Histological examination revealed tall cell variant of papillary thyroid carcinoma associated with SCC of the right lobe of the thyroid and Hashimoto's thyroiditis. Immunohistochemistry of the SCC showed positive staining for p53 and Ki67 and negative staining for thyroglobulin. The patient underwent adjuvant radioactive iodine therapy and radiotherapy. With postoperative follow-up of 24 months, the patient was in good health.DiscussionIn conclusion, the most probable origin of SCC in this case was malignant transformation from Hashimoto's thyroiditis following a phase of metaplasia. This immunohistological profile is associated with a better prognosis. Optimal treatment consists of extensive surgical resection of tumour tissuefollowed by radiotherapy.