结节性甲状腺肿合并甲状腺癌诊治分析

目的　总结结节性甲状腺肿合并甲状腺癌的诊治经验。方法　回顾性分析 2 3例结节性甲状腺肿合并甲状腺癌的临床资料。结果　同期手术治疗结节性甲状腺肿患者 83 6例 ,合并甲状腺癌 2 3例 ( 2 .75 % ,2 3 /83 6)。病理检查结果示 :灶性癌变 3例 ,微小癌变 8例 ,乳头状癌 11例 ,乳头状癌并滤泡状癌 1例。所有患者均行术中快速冷冻病理检查 ,并根据病理检查结果采取不同的手术方式 ,术后长期服用甲状腺素片。结论　结节性甲状腺肿临床中常见 ,但并发甲状腺癌诊断困难 ,多为分化好的乳头状癌。结节性甲状腺肿的手术指征应放宽 ,术中快速冷冻病理检查有利于选择正确的手术方式 ,使治疗合理有效

Analysis of Nodular Goiter with Coexistent Thyroid Cancer

Objective To sum up the experience of the diagnosis and treatment of nodular goiter with coexistent thyroid cancer.Methods The data of 23 nodular goiter with coexistent thyroid cancer from Jan 1984 to Jun 2003 were retrospectively studeid.Results A total of 836 patients with nodular goiter received operation,and 23 cases(2.75%) were confirmed to have coexistent thyroid cancer.There were 3 cases of focal cancer,8 cases of minimal cancer,11 cases of papillary cancer and one case with papillary cancer and coexistent follicular cancer.Intraoperaive fast frozen section was performed in all patients.The various styles of thyroidectomy were performed according to the different pathological results.All cases took thyroxine in the lifetime.Conclusion Nodular goiter is a common disease,but the diagnosis of nodular goiter with coexistent thyroid cancer is difficult.The coexistent thyroid cancer is often well differentiated papillary cancer.The indications of operation for patients with nodular goiter should be expanded.Intraoperative fast frozen section is a reliable diagnostic method and is helpful for the selection of surgical pattern.