甲状腺功能亢进症伴甲状腺癌的诊断与外科治疗

目的 探讨甲状腺功能亢进合并甲状腺癌的诊断及治疗方法.方法 对1999年1月至2010年9月手术治疗的43例甲状腺功能亢进合并甲状腺癌患者的临床资料进行回顾性分析.结果 43例患者术前超声检查40例,提示甲状腺癌29例(72.5%).手术方式包括双侧甲状腺次全切除术5例、患侧全切对侧大部切除和区域性淋巴结清扫术25例、双侧全切及淋巴结清扫术11例,患侧腺叶+峡部切除术2例.术后病理报告甲状腺乳头状癌38例,滤泡状癌5例.术后暂时性低钙血症3例,饮水呛咳1例,无声音嘶哑和大出血,无再手术和死亡病例.39例获得随访,随访时间2～110个月,中位随访时间45个月,无甲状腺癌及甲状腺功能亢进复发.结论 超声检查有助于术前发现甲状腺功能亢进合并甲状腺癌.甲状腺功能亢进合并甲状腺乳头状癌的患者手术治疗效果良好,预后较好.

The diagnosis and surgical treatment of hyperthyroidism complicating thyroid carcinoma

Objective To evaluate the diagnosis and surgical treatment of primary hyperthyroidism with concurrent thyroid carcinoma. Methods The clinical data of 43 hyperthyroidism cases complicating thyroid carcinoma, confirmed by pathology at our hospital from January 1999 to September 2010 were retrospectively analyzed. Results Preoperatively 40 patients were examined by ultrasound,29 cases were diagnosed with carcinoma, the diagnostic accuracy of ultrasound was 72. 5%. Thyroidectomy was performed in all the 43 patients, including subtotal thyroidectomy (5 patients), homolateral total thyroidectomy and contralateral subtotal thyroidectomy with neck dissection (25 patients ), total thyroidectomy with neck dissection or radical neck dissection (11 patients ) and lobectomy plus isthmus resection (2 patients ).Postoperative pathology identified papillary carcinoma in 38 cases, and follicular carcinoma in 5 cases.Postoperative temporary hypocalcemia developed in 3 cases and one suffered from irritating when drinking.No hoarseness or blooding. 39 patients were followed-up from 2 to 110 months averaging 45 months, there was no tumor recurrence. Conclusions Preoperative routine ultrasonography helps to identify thyroid carcinoma that coexists with primary hyperthyroidism. The postoperative prognosis of thyroid papillary carcinoma concurrent with hyperthyroidism is satisfactory.