86例肿块型桥本病的外科治疗体会

目的总结肿块型桥本病的外科治疗经验。方法回顾性分析1990年1月~2005年12月收治的86例肿块型桥本病的手术治疗情况。结果86例均经手术治疗,术后病理均证实为桥本病。并发甲状腺癌9.3%(8/86)。双侧甲状腺次全或近全切除术后均出现甲状腺功能减退(下称甲减)。结论术中发现甲状腺质脆、水肿较甚,剖面呈新鲜肉芽样改变,特别是与颈前肌群有粘连、伴发甲减或峡部、锥体叶明显肥厚者,应高度怀疑桥本病。重视术中所见和快速切片,既要力求切除所有可疑结节,以免遗漏小癌灶,又要避免盲目切除过多的甲状腺组织。

Experience with Surgical Treatment of 86 Cases of Mass-forming Hashimoto's Disease

Objective To summarize the experience of the surgical treatment of Hashimoto's disease(HD).Methods The treatment of 86 cases of HD from January 1990 to December 2005 was analyzed retrospectively.Results All 86 cases were pathologically confirmed to be HD.Concomitant thyroid carcinoma was found in 9.3%(8/86) of them,and hypothyroidism occurred after bilateral subtotal or near total thyroidectomy.Conclusions Thyroid was found to be fragile,with marked edema.Thyroid cross-section exhibited fresh granulation.HD was highly suspected if thyroid adhered to the anterior cervical muscle group,with concomitant hypothyroidism or remarkable thickening of isthmus and pyramidal lobe of thyroid.Intraoperative findings and frozen section should be helpful for making the diagnosis.Attention should be paid to balance the surgical resection margin and the loss of functional gland.