结节性甲状腺肿合并甲状腺微小癌126例诊治分析

结节性甲状腺肿合并甲状腺微小癌(thyroid microcar-cinoma,TMC)在临床十分常见,这类病例术前诊断困难,有时术中甚至术后也会漏诊[1]。现就我院结节性甲状腺肿合并TMC的临床诊疗体会总结报告如下。     

LigaSure versus clamp-and-tie thyroidectomy for benign nodular disease

BACKGROUND: LigaSure is an alternative bipolar diathermy system (BDS) combining vessel sealing with reduced thermal spread, which has been successfully used in many abdominal operations; however, there is a little experience in open thyroidectomy. This study compares the efficacy and the advantages of the LigaSure BDS when used for total thyroidectomy for benign thyroid disease with the conventional clamp-and-tie technique. METHODS: Between May 1998 and October 2002, 517 patients underwent total thyroidectomy for benign thyroid multinodular goiter. Among them, from May 1998 until May 2000, 247 patients (group I) were operated on with the conventional clamp-and-tie technique, whereas from May 2000 until October 2003, 270 patients (group II) underwent total thyroidectomy for benign multinodular goiter with LigaSure BDS through a 4-cm transverse suprasternal incision. Demographics, pathologic characteristics, gland mass, operative time, blood loss, and complications were assessed. RESULTS: There were no intraoperative complications. Thyroid mass was similar in both groups, but the operative time was shorter in group II than in group I (mean +/- standard deviation, 71 +/- 14 minutes vs 86 +/- 22 minutes; p < .01). Intraoperative total blood loss was similar between the two groups, but postoperative drain volume was less in group II than in group I (21 +/- 15 mL; p < .01). Major post-thyroidectomy complications (ie, laryngeal nerve palsy, hematoma, and hypocalcemia) occurred less frequently in the LigaSure group than in the clamp-and-tie group (0.7%, 0.4%, 1.1% vs 4%, 2%, 4.8%, respectively; p < .05). The mean +/- standard deviation postoperative hospital stay was significantly less for the patients in group II than for those in group I (2.3 +/- 1.7 days vs 2.8 +/- 1.3 days; p < .05). CONCLUSIONS: The use of the LigaSure vessel sealer for thyroid surgery is an effective and safe alternative that reduces the overall operative time and could be successfully applied through a narrow surgical incision.     

The efficiency of performing ultrasound-guided fine-needle aspiration biopsy following mass screening for thyroid tumors to avoid unnecessary surgery

Thyroid masses are a common clinical finding, and their management remains controversial. The purpose of this study was to evaluate the clinical effect of performing routine ultrasound (US) examinations and US-guided fine-needle aspiration biopsy (US-FNAB) in the management of diffuse or nodular goiter diagnosed by mass screening. Mass screening carried out from 1993 to 1996 revealed 444 women with goiter, 322 of whom had diffuse goiter and 122 had nodular goiter. All of these patients underwent US examination, the results of which determined that 169 should undergo US-FNAB to confirm an accurate diagnosis of their thyroid tumors. Histological examinations after surgical resection revealed that 12 of the 322 patients with diffuse goiter (3.7%) and 23 of the 122 with nodular goiter (18.9%) had malignant tumors. Among the 61 thyroid tumors surgically verified, US-FNAB yielded a sensitivity rate of 93%, a specificity rate of 81%, and an accuracy rate of 90%. Insufficient aspiration was obtained from 5%. Performing US-FNAB-resulted in an elevation in the percentage of malignant tumors yielded at surgery of up to 72%. Thus, ultrasonography followed by US-guided-FNAB could be a useful routine method of evaluating thyroid tumors detected by mass screening. Moreover, a greater number of unnecessary thyroid operations can be avoided by performing US-FNAB rather than FNAB alone.     

结节性甲状腺肿的高频及彩色多普勒超声征象与病理对照分析

目的探讨结节性甲状腺肿的声像图表现与病理改变的关系,提高超声诊断价值。方法分析62例结节性甲状腺肿106个结节的高频和彩色多普勒声像图表现。结果等回声或低回声结节14个,无回声结节47个,混合性回声结节45个。16个结节内可见稍增多的点线状血流信号,3个有声晕的结节在结节周边可见到血管信号。术后病理诊断为结节性甲状腺肿伴囊性变92个,其中出血囊性变12个,囊性变乳头状增生2个;结节性甲状腺肿伴钙化25个。结论高频及彩色多普勒超声能反映出结节性甲状腺肿的病理特征,并与甲状腺腺瘤和甲状腺癌相鉴别。     

湖北省郧阳地区地方性甲状腺肿和地方性克汀病流行区环境微量元素的测定分析

本文报告了湖北省郧阳地区地甲病、地克病病区与非病区粮食、蔬菜和饮水中微量元素的测定分析结果。病区环境锌、铜含量显著低于非病区,这与病区人群头发分析结果相一致,表明病区人群锌、铜摄入不足。对微量元素与地甲病、地克病的关系作了初步探讨,认为锌、铜等微量元素在该病的发生上起着重要作用。     

结节性甲状腺肿与甲状腺瘤的临床病理分析

目的探讨结节性甲状腺肿与甲状腺瘤的临床病理特点。方法对426例结节性甲状腺肿和甲状腺瘤的病变特点进行分析研究。结果结节性甲状腺肿伴有乳头状增生为10.3%(34/330);伴有非典型增生为5.42%(18/330),原16例甲状腺肿误诊为甲状腺瘤。结论结节性甲状腺肿与多发性甲状腺瘤的鉴别有一定难度,结节性甲状腺肿伴有乳头状增生与非典型增生病例应加强随访。     

海藻-甘草含药血清对M22诱导的Nthy-ori-3-1细胞增殖的作用研究

目的 探讨海藻-甘草含药血清对人甲状腺正常细胞Nthy-ori-3-1增殖的作用,为进一步研究海藻与甘草配伍抗甲状腺肿大的作用机制奠定基础。方法 体外培养Nthy-ori-3-1细胞,使用不同浓度的促甲状腺激素受体人单克隆抗体M22作用于Nthy-ori-3-1细胞不同时间,观察M22作用的最佳浓度及时间。制备海藻-甘草含药血清,M22刺激细胞24 h后,分别给予5%、10%、15%、20%海藻-甘草含药血清干预24 h,采用CCK-8法检测各组细胞增殖情况。流式细胞术检测细胞周期分布和凋亡情况;透射电镜观察细胞形态;免疫荧光检测微管相关蛋白轻链3(microtubule-associated protein light chain3,LC3)表达情况;Western blotting检测Beclin1蛋白表达。结果 M22明显刺激Nthy-ori-3-1细胞增殖,0.125μg/mL的M22作用24 h时促增殖作用最佳（P<0.01）。经海藻-甘草含药血清干预后,细胞增殖明显抑制（P<0.05、0.01）,细胞呈现明显的凋亡形态学变化,G0/G1期细胞比例明显升高（P&l...     

Results of Upfront Therapy for Marginal Zone Lymphoma

BackgroundMarginal zone lymphomas (MZLs) are indolent disorders composed of 3 subtypes: extranodal marginal zone lymphoma (MALT), splenic marginal zone lymphoma (SMZL), and nodal marginal zone lymphoma (NMZL). Early-stage MALT is treated with radiotherapy or antibiotics, and advanced MALT and NMZL are managed with either watch and wait or chemotherapy. SMZLs are treated with splenectomy or rituximab. However, because these approaches have failed to cure patients with SMZL and NMZL, we have systematically used upfront chemotherapy for them, as well as for advanced MALT. We report the outcomes of this approach.Patients and MethodsA total of 44 patients with MZL were identified from our database and divided into 2 groups. Group 1 (22 with early-stage MALT) patients received either radiotherapy (n = 17) or antibiotics with or without surgery (n = 5). Group 2 included 9 patients with advanced MALT, 9 with SMZL, and 4 with NMZL. Group 2 was treated with FND-R (fludarabine 25 mg/m² on days 1 to 3, mitoxantrone 10 mg/m² on day 1, dexamethasone 20 mg on days 1 to 5, and rituximab 375 mg/m² on day 1; n = 14) or CHOP-R (cyclophosphamide 750 mg/m² on day 1, doxorubicin 50 mg/m² on day 1, vincristine 2 mg intravenous push on day 1, prednisone 100 mg/m² orally on days 1 to 5, rituximab 375 mg/m² on day 1; n = 8), followed by maintenance rituximab for 70%.ResultsAll patients achieved complete remission, and only 2 patients in group 1 had developed a relapse at 70 and 75 months. Both relapses were stage I MALT that had initially been treated with radiotherapy. Both were salvaged with FND-R and remained free of disease at 27 and 39 months after the relapse. At 10 years, the failure-free survival for the 44 patients was 80% and the overall survival was 100%. None of the patients in group 2 developed a relapse. The long-term toxicities have been acceptable.ConclusionsThe excellent responses using upfront chemotherapy for MZL suggests that this disorder is curable. Our results should be confirmed in a prospective trial.     

Hodgkin Lymphoma of the Oral Mucosa

In this report, we describe a rare case of relapsed nodular sclerosing Hodgkin lymphoma presenting as a lesion of the oral mucosa. Although this is an uncommon clinical scenario, health care professionals should be aware of this possibility. A brief differential diagnosis and review of Hodgkin lymphoma is discussed.