结节性甲状腺肿合并分化型甲状腺癌诊断与治疗

目的：探讨结节性甲状腺肿合并分化型甲状腺癌的临床特点及诊治原则。 方法：回顾性分析2003年10月—2011年10月收治的47例结节性甲状腺肿合并分化型甲状腺癌的临床资料。 结果：患者均表现为颈部包块或颈部增粗，术前B超显示结节伴细沙粒样钙化者19例（40.43%）。47例患者均行手术治疗，术后经病理学检查确诊为分化型甲状腺癌（其中乳头状癌36例，占76.60%；滤泡样癌11例，占23.40%），手术方式包括：患侧腺叶+峡部全切术+VI区淋巴结清扫；两侧腺叶+峡部全切术+VI区淋巴结清扫；颈部淋巴结肿大、转移者加行改良颈清扫术。术后均给予左旋甲状腺素片治疗。47例患者术后随访6~36个月，平均为（15.6±8.9）个月，3例分别于术后16~33个月复发，再次手术，效果良好。全组无死亡病例。 结论：结节性甲状腺肿合并甲状腺癌术前诊断困难，术前超声检查可提供可考依据，术中快速冷冻切片病理学检查是提高甲状腺癌检出率的关键；个体化、精细规范的手术治疗对结节性甲状腺肿合并分化型甲状腺癌有良好的治疗效果。

Diagnosis and treatment of nodular goiter with differentiated thyroid carcinoma

Objective: To investigate the clinical features and principles for the diagnosis and treatment of nodular goiter with differentiated thyroid cancer. Methods: The clinical data of 47 patients with differentiated thyroid cancer in nodular goiter admitted from October 2003 to October 2011 were retrospectively analyzed. Results: All of the patients presented with neck mass or neck enlargement, and preoperative B ultrasound showed that 19 cases (40.43%) had small sand-like calcification in the thyroid nodules. The 47 patients underwent surgical treatment and were diagnosed to have differentiated thyroid cancer by postoperative pathological examination (36 cases of papillary carcinoma, accounting for 76.60% and 11 cases of follicular carcinoma, accounting for 23.40%). The surgical procedures performed included total ipsilateral lobectomy and isthmectomy plus level VI lymph node dissection, bilateral lobectomy and isthmectomy plus level VI dissection, and modified radical neck dissection that was additionally performed in cases with positive cervical lymph nodes. All patients received levothyroxine treatment after operation. These 47 patients were followed up for 6 to 36 months with average of (15.6±8.9) months after operation. Three cases developed recurrence within 16 to 33 months after operation and all underwent successful re-operation. No death occurred in the entire group. Conclusion: The preoperative diagnosis of nodular goiter with thyroid cancer is often difficult, for which preoperative ultrasound can provide useful information, and the pathological examinations of intraoperative fast frozen-section are critical for increasing the detection rate of thyroid cancer. The individualized, meticulous and standardized surgical treatment can provide a better prognosis for patients with concomitant nodular goiter and differentiated thyroid cancer.