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目的探讨桥本氏病(Hashimoto’s disease,HD)合并甲状腺癌(Thyroid Cancer,TC)的诊断和手术治疗的适应症及其疗效。方法回顾性分析2008年9月～2012年03月经手术及病理证实的17例HD合并TC患者的临床资料,分析其诊断和治疗。结果在本组17例HD合并TC病例中,术前误诊、漏诊率高达88.2%(15/17)。术中快速病理明确诊断准确率为94.1%(16/17)。行患侧腺叶全切除+峡部切除+对侧次全切除13例,甲状腺全切除4例(其中1例为二次手术),加行中央组淋巴结清扫10例,术中见癌肿侵犯喉返神经的1例。术后均服用甲状腺素进行内分泌治疗。所有患者均获随访,无一例复发、转移或死亡。结论 HD合并TC术前明确诊断困难,漏诊率高,多数术中快速病理可确诊。对HD合并单发的甲状腺肿块有恶性可能、甲状腺肿大产生压迫症状、合并疼痛、内分泌治疗无效及短期内肿物明显增大的HD病人应积极手术治疗。术中根据快速病理结果决定具体手术方式,通过个体化的手术治疗联合术后内分泌治疗,预后良好。
Objective To investigate the diagnosis and surgical treatment of Hashimoto’s disease (HD) combined with Thyroid Cancer (TC). Methods The clinical data of 17 patients with HD complicated with TC confirmed by surgery and pathology from September 2008 to March 2012 were analyzed retrospectively. The diagnosis and treatment were analyzed. Results In the 17 cases of HD with TC, the misdiagnosis rate before operation was 88.2% (15/17). The rapid diagnostic accuracy of intraoperative fast pathology was 94.1% (16/17). Total ileum lobectomy + isthmus resection + contralateral subtotal resection in 13 cases, total thyroidectomy in 4 cases (1 case of second surgery), plus the central group of lymph node dissection in 10 cases, see the surgery to see the tumor invasion throat Back to the nerve in 1 case. After taking thyroxine for endocrine therapy. All patients were followed up without recurrence, metastasis or death. Conclusions The diagnosis of HD complicated with TC is difficult to diagnose before operation, and the rate of misdiagnosis is high. Most of the patients can be diagnosed quickly by pathology. HD combined with single-handed thyroid tumor may be malignant, oppression thyroid enlargement symptoms, pain, endocrine therapy ineffective and significant increase in short-term mass in patients with HD should be actively surgically treated. Intraoperative rapid pathological results according to determine the specific surgical approach, through individualized surgical treatment combined with postoperative endocrine therapy, the prognosis is good.