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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。
Objective: To investigate the clinical features and diagnosis and treatment of nodular goiter complicated with differentiated thyroid cancer. Methods: The clinical data of 47 patients with nodular goiter complicated with differentiated thyroid carcinoma admitted to our hospital from October 2003 to October 2011 were analyzed retrospectively. Results: All the patients showed the thickening of the neck mass or neck. Preoperative B-ultrasound showed nodules with fine-grained calcification in 19 cases (40.43%). Forty-seven patients underwent surgical treatment. Thirty-six patients with differentiated thyroid cancer were diagnosed pathologically (36 of them were papillary carcinoma, accounting for 76.60%; 11 were follicular carcinoma, accounting for 23.40%). Surgical methods included: Gland lobectomy + isthmic resection + lymph node dissection in VI; bilateral lobectomy + isthmic resection + lymph node dissection in VI; cervical lymph nodes, metastasis plus modified neck dissection. Postoperative levothyroxine tablets were given. Forty-seven patients were followed up for 6 to 36 months, with an average of (15.6 ± 8.9) months. Three patients relapsed 16 to 33 months after operation, respectively. No deaths in the whole group. Conclusion: Preoperative diagnosis of nodular goiter complicated with thyroid cancer is difficult. Preoperative sonographic examination can provide the basis for examination. The rapid intraoperative frozen section biopsy is the key to improve the detection rate of thyroid cancer. Individualized and fine standardized operation Treatment of nodular goiter with differentiated thyroid cancer have a good therapeutic effect.