38例亚急性甲状腺炎结节外科诊治和病理分析

目的探讨提高外科对亚急性甲状腺炎结节的诊治水平。方法复习38例亚甲炎的临床诊治和病理资料，重新阅读临床和病理切片、确诊，并对2例合并甲状腺乳头状微小癌加作免疫组化标记，并参考文献进行分析。结果男3例，女35例，30~60岁28例（73.68%），病程2 d~2年8个月。均以主诉甲状腺肿物/结节而就诊。28例单纯亚甲炎者无（或未记录）临床表现；10例亚甲炎合并结甲肿者均出现过颈前疼痛/压痛、咽喉疼痛、甲亢症状，以及发热、呛咳等。术前临床诊断：亚甲炎症1例（2.63%），疑甲癌2例，甲瘤6例，结甲肿11例，甲状腺肿物18例；术中冰冻诊断：亚甲炎38例（准确率100%），其中10例亚甲炎+结甲肿（含2例伴微小乳头状癌）；病理诊断：亚甲炎28例（73.68%）；亚甲炎+结甲肿8例（21.05%）；甲状腺乳头状微小癌+亚甲炎+结甲肿2例（约5.26%）。治疗：38例均行病变甲状腺组织切除术，10例术后适当加用药物治疗，愈后良好。术后有33例随访1年2个月~9年6个月，其中：28例单/双侧亚甲炎者，正常生活、工作，5例双侧亚甲炎+结甲肿者，出现甲功低下需长期服药维持。结论亚甲炎缓解/恢复期患者，多因甲状腺肿物/结节于外科就诊，易误诊误治。术中进行冰冻切片诊断，对掌控手术切除病变组织范围，避免过治疗，极为重要，且可使治疗取得良好疗效

The Pathological analysis and surgical diagnosis and treatment in subacute in nodular thyroiditis in 38 cases

ObjectiveTo improve the diagnosis and treatment of subacute thyroiditis with mass or nodule in surgery.MethodsThirty-eight cases of subacute thyroiditis were reviewed in the clinical and pathological data and restudied their pathological sections. Among them, two cases who accompanied with papillary thyroid microcarcinoma were processed by immunohistochemical marks.ResultsThe patients included 3 cases of males and 35 cases of females in a course of disease from 2 days to 2 years and 8 months. Among them, 28 cases were in 30-60 years old (73.68%). Every patient complained about masses or nodules in thyroid glands. There were no uncomfortable symptoms in 28 cases with subacute thyroiditis. The other 10 cases manifested pain or tenderness in the anterior region of the neck, sore throat, hyperthyroidism, fever and choking and so on. The diagnoses before operation contained subacute thyroiditis in a case (2.63%), suspected thyroid cancer in 2 cases, thyroid tumor in 6 cases, nodular goiter in 11 cases, thyroid mass in 18 cases. The diagnoses of frozen section during operation had subacute thyroiditis in 38 cases (accuracy in 100%). Among them, 10 cases of subacute thyroiditis with nodular goiter accompanying with 2 cases of papillary thyroid microcarcinoma. The pathological diagnoses confirmed subacute thyroiditis in 28 cases (73.68%); subacute thyroiditis with nodular goiter in 8 cases (21.05%); papillary thyroid microcarcinoma with subacute thyroiditis and nodular goiter in 2 cases (about 5.26%). Treatment: All cases had been treated by thyroidectomy. Among them, 10 cases were administered prompt medicine with good prognosis. There were 33 cases who were followed up from 1 year and 2 months to 9 years and 6 months after operation. Twenty eight cases with unilateral or bilateral subacute thyroiditis recovered very well in normal life and work. Five cases with bilateral subacute thyroiditis and nodular goiters had hypothyroidism and needed medicine in long term.ConclusionThe patients with subacute thyroiditis in its remission and recovery period often go to the department of surgery because of thyroid mass or nodule and are apt to misdiagnosis. Frozen section during operation is important to confirming the resection extent, avoiding excessive resection and getting good treatment effectiveness.