甲状腺结节的规范诊治

目的 探讨甲状腺结节的规范诊治,避免过度诊治问题.方法 回顾大连医科大学附属第二医院2005年1月至2009年12月间住院的2 581例甲状腺结节诊治的临床资料,分析各主要诊治方法在临床中的应用情况,总结目前甲状腺结节较为规范的诊治方法和可以避免的过度诊治情况.结果本组2 581例患者术前检查以超声最为常见,约占90%,且含有2个或2个以上超声检查危险特征者对恶性结节敏感性92.9%,特异性44.3%,所有患者根据实际病情行不同手术治疗,其中单发低危微小癌患者行单侧腺叶加或不加峡部切除术后2.5年复发率4%.结论 甲状腺结节的诊治方法多种多样,超声作为初检在术前诊断上特异性、敏感性较高,且较为经济,治疗仍以手术治疗为最主,合理选择诊治方法是避免甲状腺结节过度诊治的关键.

Diagnosis and treatment of thyroid nodule: standard discussion

Objective To discuss the standard diagnosis and treatment for thyroid nodule.Methods 2 581 patients with thyroid nodule from 2005 to 2009 were studied.Common methods of examination and treatment were analyzed to avoid over-examination and over-treatment.Results 90%of the patients underwent ultrasound examination with a 92.9%sensitivity and 44.3%specificity when there were two or more risk characters.All patients underwent certain kinds of surgery according to their clinical conditions.The recurrence rate was 4%two and half years after lateral thyroid adenectomy or thyroid surgery without excision of thyroid isthmus.Conclusions There are many approaches to thyroid nodule examination and treatment,in which ultrasound is recommended for preoperative examination because of its higher sensitivity,specificity and lower cost,and surgery is still the most useful and effective treatment.Choosing the proper method for thyroid nodule diagnosis and treatment is the key point to avoid over-examination and over-treatment.