医学理论与实践
醫學理論與實踐
의학이론여실천
The Journal of Medical Theory and Practice
2014年
8期
985-987
,共3页
冯勇%石继红%张建新%林鹏
馮勇%石繼紅%張建新%林鵬
풍용%석계홍%장건신%림붕
桥本甲状腺炎%甲状腺乳头状癌%外科治疗
橋本甲狀腺炎%甲狀腺乳頭狀癌%外科治療
교본갑상선염%갑상선유두상암%외과치료
Hashimoto’s throiditis%Papillary thyroid cancer%Surgical treatment
目的：探讨近年来桥本甲状腺炎并发甲状腺乳头状癌的发病特点和外科治疗方法，来提高对该病诊断和治疗的认识。方法：回顾性分析2008-2013年天津医科大学第四中心临床学院手术切除的，且均有病理证实的单纯桥本甲状腺炎（HT）208例，桥本甲状腺炎（HT）并发甲状腺乳头状癌（PTC）52例，通过对照比较其年龄、病程、肿物体征、彩超特点、促甲状腺激素（TSH）指标及外科治疗方式与效果，总结分析 HT 并发 PTC的高危特征与预后特点。结果：HT并发PTC占同期260例经病理证实为HT病例的20％（52/260）。两者比较，HT并发PTC年龄偏大，病程较长，TSH增高者多；结节样肿大较弥漫性肿大者癌变率高，彩超砂粒样微钙化发生率高，差异均具有统计学意义（P＜0．05）。经外科手术治疗后发现 HT并发PTC患者临床分期较早，淋巴结转移率偏低、复发率低，术后甲低率较高。结论：HT并发PTC的发生率呈上升趋势；对于病程长合并TSH增高明显，甲状腺结节状增大的中年女性桥本甲状腺炎患者，如内科治疗效果欠佳，定期复查彩超提示肿物内砂粒样钙化者，可作为筛选癌变的高危特征；经外科治疗后HT并发PTC的愈后较好。
目的：探討近年來橋本甲狀腺炎併髮甲狀腺乳頭狀癌的髮病特點和外科治療方法，來提高對該病診斷和治療的認識。方法：迴顧性分析2008-2013年天津醫科大學第四中心臨床學院手術切除的，且均有病理證實的單純橋本甲狀腺炎（HT）208例，橋本甲狀腺炎（HT）併髮甲狀腺乳頭狀癌（PTC）52例，通過對照比較其年齡、病程、腫物體徵、綵超特點、促甲狀腺激素（TSH）指標及外科治療方式與效果，總結分析 HT 併髮 PTC的高危特徵與預後特點。結果：HT併髮PTC佔同期260例經病理證實為HT病例的20％（52/260）。兩者比較，HT併髮PTC年齡偏大，病程較長，TSH增高者多；結節樣腫大較瀰漫性腫大者癌變率高，綵超砂粒樣微鈣化髮生率高，差異均具有統計學意義（P＜0．05）。經外科手術治療後髮現 HT併髮PTC患者臨床分期較早，淋巴結轉移率偏低、複髮率低，術後甲低率較高。結論：HT併髮PTC的髮生率呈上升趨勢；對于病程長閤併TSH增高明顯，甲狀腺結節狀增大的中年女性橋本甲狀腺炎患者，如內科治療效果欠佳，定期複查綵超提示腫物內砂粒樣鈣化者，可作為篩選癌變的高危特徵；經外科治療後HT併髮PTC的愈後較好。
목적：탐토근년래교본갑상선염병발갑상선유두상암적발병특점화외과치료방법，래제고대해병진단화치료적인식。방법：회고성분석2008-2013년천진의과대학제사중심림상학원수술절제적，차균유병리증실적단순교본갑상선염（HT）208례，교본갑상선염（HT）병발갑상선유두상암（PTC）52례，통과대조비교기년령、병정、종물체정、채초특점、촉갑상선격소（TSH）지표급외과치료방식여효과，총결분석 HT 병발 PTC적고위특정여예후특점。결과：HT병발PTC점동기260례경병리증실위HT병례적20％（52/260）。량자비교，HT병발PTC년령편대，병정교장，TSH증고자다；결절양종대교미만성종대자암변솔고，채초사립양미개화발생솔고，차이균구유통계학의의（P＜0．05）。경외과수술치료후발현 HT병발PTC환자림상분기교조，림파결전이솔편저、복발솔저，술후갑저솔교고。결론：HT병발PTC적발생솔정상승추세；대우병정장합병TSH증고명현，갑상선결절상증대적중년녀성교본갑상선염환자，여내과치료효과흠가，정기복사채초제시종물내사립양개화자，가작위사선암변적고위특정；경외과치료후HT병발PTC적유후교호。
To study the clinical characteristics and surgical treatment of Hashimoto ’s thyroiditis with papil-lary thyroid cancer in recent years ,to improve understanding of the disease diagnosis and treatment .Methods :a retro-spective analysis of Fourth Central Hospital of Tianjin Medical University 2008 to 2013 operation excision ,and all have the pathology of pure Hashimoto thyroiditis (HT) in 208 cases ,Hashimoto’s thyroiditis (HT) patients coexisted with papillary thyroid cancer (PTC) in 52 cases ,by comparison of their age ,course of disease ,tumor ,ultrasound characteris-tics of signs ,thyroid stimulating hormone (TSH) index and the surgical treatment method and effect ,summarizes the characteristics and prognosis of high-risk characteristics analysis of HT coexisted with PTC .Results:HT coexisted with PTC accounted for 20% (52/260) the same period in 260 patients with pathologically confirmed cases of HT .By com-parison ,HT coexisted with PTC ,older age ,longer course ,TSH level is higher ;canceration rate of nodular enlargement is higher than diffuse enlargement ,ultrasound sand-like micro-calcification rate is higher ,the differences were statisti-cally significant (P<0 .05) .After the surgical operation treatment ,we find the clinical stage is earlier ,lymph node metastasis rate is low ,the recurrence rate is low ,and a higher rate of postoperative hypothyroidism .Conclusion:The incidence of HT coexisted with PTC is rising ;for long course with TSH increased significantly ,middle-aged women patients of Hashimoto’s thyroiditis with thyroid nodular enlargement ,such as poor treatment of internal medicine ,ul-trasound intratumoral sand-like micro-calcification ,can be used as a screening high-risk characteristics of cancer .After surgical treatment ,the prognosis of patients are better in HT coexisted with PTC .
