桥本氏甲状腺炎合并结节的外科治疗

目的:探讨合并结节的桥本氏甲状腺炎临床发病关系及其诊断、治疗和预后。方法:收集我院2003～2007年外科手术治疗并经病理证实合并甲状腺结节的桥本氏甲状腺炎224例病例资料及随访资料进行回顾性分析,分析其临床特征(肿瘤大小、手术方法),探讨其手术适应证,手术范围及术后发生甲状腺功能减低的原因。结果:全组病例均并发甲状腺结节,其中甲状腺癌24例,甲状腺腺瘤17例,甲状腺机能亢进22例,结节性甲状腺肿121例,40例为单纯桥本氏甲状腺炎。224例均行外科手术治疗,术中行快速病理检查,根据病检行不同范围的甲状腺切除术,术后全组病例服用优甲乐,随访6个月～4年,61%的病例复查甲状腺功能正常,6个月后停药。并发甲癌者终生服药外,有37例出现甲状腺功能减退,长期服药。结论:对于合并甲状腺结节的桥本氏甲状腺炎应考虑手术治疗。桥本氏甲状腺炎合并甲状腺结节术前常规测甲状腺功能、彩色多普勒B超检查,CT检查及同位素扫描,术中快速冰冻切片,有利于术前、术中确诊及正确的手术方式选择。

The surgical therapy of hashimoto disease which combined thyroid tubercle

Objective:To investigate the clinical effect of surgical treatment on Hashimoto disease(HD) complicated with thyroid tubercles.Methods:Two hundred and tweney four cases with HD treated by surgical operations and confirmed by pathological examinations from Jan 2003 to Oct 2007 were reported,and the relation between operative style,extent and postoperative effect,hypothyroidism were analyzed.Results:All cases were complicated with thyroid tubercles,among which 10 were thyroid cancer,8 cases were thyroid tumor,14 were hyperthyroidism,18 were nodular goiter and the others were lymphomatosa tubercles of HD.According to the different circumstances,the various styles of thyroidectomy were performed,of which total and subtotal thyroidectomies of one or bilateral lobes were performed on 61% of all cases.All cases were given thyroxine and followed up for 2 years and no one presented hypothyroidism.Thyroxine was withdrawn in 67% of all cases.In 5 years' follow-up,all cases withdrew thyroxine except the patients with thyroid cancer.Only 2 cases presented hypothyroidism.Conclusion:HD complicated with thyroid tubercles should be treated surgically.The operative styles should be selected according to the disease conditions.The occurrence rate of hypothyroidism was low within 5 years after operation.