桥本甲状腺炎合并甲状腺癌的诊断与治疗

目的总结桥本甲状腺炎（HT）合并甲状腺癌（TC）的诊断和治疗方法,以提高对该病的认识。方法搜集笔者所在医院2008年1月至2011年12月期间收治并行手术治疗的184例HT患者的临床资料,对其中合并TC的32例患者的临床资料进行回顾性分析。结果 184例HT患者中,合并TC者32例,占17.4%,均按TC的治疗原则行手术治疗。术前经细针穿刺细胞学检查（FNAC）诊断为HT合并TC者15例,灵敏度为46.9%（15/32）;术中经快速冰冻切片病理学检查诊断为HT合并TC者27例,灵敏度为84.4%（27/32）,高于FNAC检查的灵敏度（χ2=7.563,P=0.004）。术后经常规石蜡切片和（或）免疫组化病理学检查证实为HT合并甲状腺乳头状癌（PTC）者30例,合并甲状腺滤泡状癌（FTC）者2例。术后所有患者均采用左旋甲状腺素（L-T4）进行抑制和（或）替代治疗;有5例患者另加行131I治疗。术后1例患者出现手足抽搐,2例患者出现轻度声嘶,余无其他并发症发生。本组32例患者获访29例,失访3例;随访时间为3～49个月,平均35个月。随访期间,无复发、转移及死亡。结论 HT合并TC的术前诊断率低,辅助检查对提高该病的诊断率及指导治疗具有重要的临床价值;手术是其首选治疗方式,术后的辅助治疗不可或缺。

Diagnosis and Treatment of Hashimoto Thyroiditis Coexistence with Thyroid Cancer

Objective To summarize the diagnosis and treatment of Hashimoto thyroiditis（HT）coexistence with thyroid cancer（TC）.Methods One hundred and eighty-four patients with HT treated in The Affiliated Hospital of Guiyang Medical College from Jan.2008 to Dec.2011 were collected,and clinical data of 32 patients with TC of them were analyzed retrospectively.Results Thirty two patients combined with TC of the 184 patients with HT,and the incidence rate was 17.4%.All of the 32 patients were treated surgically according to the principle of surgery treatment for TC.Of the 32 cases of HT coexistence with TC,15 patients were diagnosed by preoperative fine needle aspiration cytology（FNAC）,and the sensitivity of FNAC was 46.9%（15/32）.Twenty seven patients were diagnosed by intraoperative frozen section pathological examination,and the sensitivity of it was 84.4%（27/32）,which was significantly higher than those of FNAC（χ2=7.563,P=0.004）.Thirty patients were diagnosed as papillary thyroid carcinoma（PTC）,and 2 patients were diagnosed as follicular thyroid carcinoma（FTC）by postoperative paraffin section pathological examination and（or）immunohistochemistry,respectively.All patients were treated with levothyroxine（L-T4）after operation,and 5 patients were treatment with131I therapy in addition.One patient suffered convulsion,and 2 patients suffered mild hoarsenessthere after operation.Only 29 patients were followed up for 3-49 months（average 35 months）,and during the followed up,there were no tumor recurrence,metastasis,and death.Conclusions The rate of preoperative diagnosis of HT coexistence with TC is low,and auxiliary examinations play an important role in diagnosis and guiding treatment.Surgery is the preferred treatment,but auxiliary therapies after surgery are indispensable too.