桥本病合并甲状腺乳头状癌106例诊治体会

目的]总结桥本病(HD)合并甲状腺乳头状癌(PTC)的外科诊断、治疗及预后.方法]回顾分析1996年1月至2010年12月哈尔滨医科大学附属第二医院经手术后病理证实为HD合并PTC 106例病人的临床资料.结果]106例均经手术治疗,HD合并PTC的发病率占HD的17.24%,占PTC的10.16%.所有病人术前...

Diagnosis and Treatment of 106 Cases of Hashimoto's Disease Complicated with Thyroid Papillary Carcinoma

Objective] To summarize the surgical diagnosis, treatment and prognosis of Hashimoto＇s disease （HD） complicated with thyroid papillary carcinoma（PTC）. Methods] Clinical data of 106 cases of HD complicated with PTC confirmed by pathology after surgery in second affiliated hospital of Harbin medical university from Jan. 1996 to Dec. 2010 were analyzed retrospectively. Results] All 106 patients were treated by surgery. The incidence of HD with PTC was 17. 240/00 in HD and 10. 16% in PTC. All patients preoperatively complained of neck mass. All, one or both of thyroid peroxidase antibodies, thyroglobulin antibodies and thyroid microsomal antibodies of 102 patients increased. There were 3 cases of HD, 26 cases of HD with thyroid cancer, 3 cases of thyroid carcinoma, 47 cases of HD with nodular goiter, 24 cases of nodular goiter, 1 ease of adenomatous nodules, 2 cases of thyroid carcinoma with nodular goiter and 9 cases of lymphadenectasis diagnosed by ultrasound. Fine needle aspiration of 67 cases showed that 41 cases were HI） with PTC. Radioisotope scanning of 23 cases showed that 8 cases were cold nodules. According to the location and nature of the lesion and intraoperative frozen section, the surgical methods were chosen. With the pathological diagnosis as the standard, the accuracy rate of preoperative diagnosis of HI） and thyroid cancer was 85.85 % and 33.96% , respectively, and that of intraoperative frozen result diagnosis of HD and thyroid cancer was 81.13 % and 97.20 %, respectively. One case recurred 3 years after operation. No recurrence and metastasis was found in other cases. Conclusion] The clinical diagnosis of HD with PTC is more difficult. Preoperative routine detection of thyroglobulin antibodies, thyroid microsomal antibodies and thyroidperoxidase antibodies, ultrasound, fine needle aspiration of some patients, radioisotope scan and intraoperative rapid frozen section are helpful for final diagnosis and the choice of correct surgical approaches. Surgical treatment should be considered for HD complicated with thyroid nodules.