桥本病并发甲状腺癌临床分析.docVIP

桥本病并发甲状腺癌临床分析 　　作者：王铨,杜培泽,石玉生,赵建勋 　　河北省迁安市，首钢矿山医院普外科 北京门头沟区医院普外科 北京大学第一医院普外科 　　【关键词】 桥本病;甲状腺癌;外科治疗 　　摘要 目的 探讨桥本病并发甲状腺癌的临床发病关系及诊断、治疗和预后。方法 回顾性分析1989―2004年56例桥本病并发甲状腺癌7例资料。结果 本组桥本病并发甲状腺癌发病率为12.5%(7/56)。全组出现甲状腺结节的患者均进行了手术治疗，甲状腺癌7例平均随访6.5年无死亡及复发，预后好。结论 对于并发甲状腺结节的桥本病应考虑手术治疗。桥本病并发甲状腺癌临床诊断较困难。术前常规测血抗甲状腺球蛋白抗体(ATGA)、抗微粒体抗体(MCA)、甲状腺核素显影、细针穿刺、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。 　　CLINICAL ANALYSIS OF HASHIMOTO DISEASE COMPLICATED WITH THYROID CANCER 　　Wang Quan,Du Peize,Shi Yusheng,et al. 　　Department of General Surgery, Capital Steel Mineral Hospital, Qianan 064404,China 　　Key words hashimoto disease; thyroid cancer; surgery 　　Abstract Objective To study the clinical relationship between Hashimoto disease and thyroid cancer and its diagnosis, treatment and prognosis results. Methods Restrospective analysis was made on 56 cases with Hashimoto disease treated from 1989～2004, in which 7 cases were coexistent with thyroid carcinoma. Results The incident rate of thyroid carcinoma was 12.5%(7/56). All patients with nodules received thyroidectomy. All postoperative patients were followed up. The average survival period of thyroide cancer was 6.5 year and without recurrence. Conclusion Patients with nodules should be treated by surgery. The clinical diagnosis of coexistence of Hashimoto disease and thyroid cancer is still difficult. The key to diagnosis and rational treatment includes detailed understanding of clinical feature, routine examination of serum antibodies and scintigraphic thyroid scan or FNAB and quick frozen pathologic section in operation. 　　桥本病临床表现不典型，在临床上本病有发展成甲状腺癌的可能性或出现压迫症状。我们主张对有结节的桥本病进行手术治疗，我院1989―2004年收治56例桥本病，其中7例并发甲状腺癌，现分析报告如下。 　　1 临床资料 　　1.1 一般资料 56例桥本病并发甲状腺癌7例。7例中女6例，男1例。年龄20～68岁。其中30～50岁占75.5%，平均40.5岁。首发症状均为甲状腺肿大或结节。2例伴有疼痛。1例伴有呼吸不畅。病程0.5个月~15年，平均6.5个月。甲状腺弥漫性肿大Ⅰ～Ⅱ度6例，Ⅲ度1例。并发单个结节4例，结节性肿大3例，直径最大6.0cm，最小0.5cm。术前均测血清T3、T4、TSH，其中T4增高1例。T4和FT4降低1例，TSH增高2例，T3均正常，行抗甲状腺球蛋白抗体(ATGA)和抗微粒体抗体(MCA)检查1例，为阳性。B超检查提示甲状腺癌2例，结节性甲状腺肿3例，甲状腺瘤1