结节性甲状腺肿合并甲状腺癌的诊治分析

目的提高结节性甲状腺肿合并甲状腺癌的诊断和治疗水平。方法回顾性分析我院近年收治的158例结节性甲状腺肿患者的临床资料，所有患者均首先采用单侧或双侧甲状腺次全切除术，术中送冰冻病理检查，根据冰冻病理结果或石蜡切片病理结果补充行患侧甲状腺叶全切＋峡部＋对侧甲状腺叶次全切除术。结果158例结节性甲状腺肿患者中，合并甲状腺癌23例，其中乳头状腺癌22例，滤泡状腺癌1例。术后随访5-12个月，1例患者出现颈部淋巴结肿大，再次行功能性颈部淋巴结清扫术。Logistic回归分析显示，判断结节性甲状腺肿合并甲状腺癌的因素中，结节个数较少与结节直径较小是结节性甲状腺肿合并甲状腺癌的危险因素。结论对某些虽然无明确症状，但发现甲状腺有较小的实性结节的结节性甲状腺肿患者应持更积极的治疗态度。

Diagnosis and treatment of nodular goiter with coexistent thyroid cancer

Objective Improvement of diagnosis and treatment of nodular goiter with coexistent thyroid cancer. Methods The 158 cases of nodular goiter treated in our hospital were retrospectively analyzed,in which unilateral or bilateral subtotal thyroideetomy was performed and intraoperative frozen section examination was applied to determine if an additional operation was needed. Results In 158 patients with nodular goiter ,23 cases of thyroid cancer were detected, including 22 cases of papillary adenocarcinoma and 1 case of follicular adenocarcinoma. During the follow -up for 5 to 12 months, cervical lymph node enlargement occurred in 1 case, and a functional cervical lymph node dissection was performed. The logistic regression analysis showed that fewer and smaller nodules in the thyroid would be one of the risk factors of coexistent thyroid cancer. Conclusion For the cases of nodular goiter with no clinical symptoms but showing small, solid nodules in the thyroid, a more active attitude should be taken to the operation.