甲状腺单发结节355例临床诊治分析

目的：探讨甲状腺单发结节的诊断和治疗方法。方法：回顾性分析355例单发性甲状腺结节患者的临床资料。结果：超声提示结节〈1．0cm者5例，其中1例因突然增大而手术，其余4例大小无变化。结节大小在1．0-1．5cm者15例，口服甲状腺素片后其中3例逐渐减小；余12例行手术切除。结节〉1．5cm者335例均采用手术治疗。手术病例全部行单侧腺叶加峡部切除术。手术病例术后病理回报：结节性甲状腺肿220例，腺瘤32例，桥本甲状腺炎3例。乳头状癌83例，滤泡状癌8例，髓样癌2例。355例中恶性率约为26．20％（93／355）。大小在1．5cm以下的恶性率为5％（1／20），大于1．5cm的恶性率为27．46％（92／335），差异有统计学意义（P〈0．05）。所有手术病例随访1-2年均未见复发，无死亡。结论：高频超声检查可以为甲状腺单发结节的诊断提供可靠依据．并对临床治疗方法的选择具有一定指导意义；甲状腺单发结节的治疗应视不同情况而定，单发结节大小在1．5cm以上者应积极手术治疗，手术术式首选单侧腺叶加峡部切除术。

Analysis of diagnosis and management in 355 patients with thyroid single nodule

Objective： To investigate the appropriate means of diagnosis and management of the single nodule of thyroid. Methods： The clinical data of 355 patients with thyroid single nodule from 2004 to 2008 were collected and retrospectively analyzed. Results：In 5 cases the mass diameter was less than1.0 cm by ultrasonography, including 1 case surgically treated due to suddenly enlarging and 4 cases no changes. In 15 cases the nodule diameters were from 1.0 cm to 1.5 em, 3 of them the thyroid nodules gradually decreased following taking thyroxin tablets; the other 12 patients underwent surgical procedure. All 335 patients with thyroid nodule which the diameters were more than 1.5 cm were received operation. All operative patients were undergone thyroid lobectomy and isthmus resection. 220 cases of nodule goiter, 32 cases of adenoma, 3 cases of Hashimoto disease, 83 cases of papillary carcinoma, 8 cases of follicular carcinoma and 2 cases of medullary carcinoma were pathologically determined. The malignancy incidence in total 355 patients was 26.20% （93/355）. The malignancy incidence of nodule less than 1.0 cm was 5%（ 1/ 20） and of larger than 1.5 cm was 27.46% （92/335）,respectively. There was significantly difference between the two groups （P〈0.05）.Recurrence and death were not found in the duration of 1~2 years following - up. The patients had hopefully better prognosis. Conclusion：High frequency uhrasonography is very useful in the preliminary diagnosis of thyroid single nodule and help to choose the management. The different treatments should be individually selected. When the nodule is larger than 1.5 cm , surgical procedure is necessary and thyroid lobectomy and isthmus resection should be the first proper choice.