CAJ | 학술논문

目的探讨甲状腺功能亢进合并甲状腺癌的诊断及治疗方法.方法回顾性分析北京协和医院从1983年1月至2009年7月收治的并经外科手术治疗和病理证实的48例甲状腺功能亢进合并甲状腺癌患者的临床资料.结果甲状腺功能亢进合并甲状腺癌患者占同期甲状腺功能亢进手术患者的2.02%(48/2378),占同期甲状腺癌手术患者的3.03%(48/1584).手术方式包括双侧甲状腺大部切除术(31例)、患侧全切对侧大部切除和区域性淋巴结清扫术(6例)、双侧全切及淋巴结清扫术(11例).术前超声诊断阳性率为61.3%,甲状腺核素显像的诊断阳性率为62.5%;48例患者中获随访40例,时间1～264个月,中位随访时间130.5个月.随访中无甲状腺功能亢进复发病例,2例患者术后第二年出现肺、骨转移.结论超声检查和核素显像对于术前诊断有重要意义,甲状腺功能亢进合并甲状腺隐匿癌和微小癌的临床诊断较困难,多于手术后病理诊断.甲状腺功能亢进合并甲状腺乳头状癌的患者手术治疗效果良好,预后较好.
목적 탐토갑상선공능항진합병갑상선암적진단급치료방법.방법 회고성분석북경협화의원종1983년1월지2009년7월수치적병경외과수술치료화병리증실적48례갑상선공능항진합병갑상선암환자적림상자료.결과 갑상선공능항진합병갑상선암환자점동기갑상선공능항진수술환자적2.02%(48/2378),점동기갑상선암수술환자적3.03%(48/1584).수술방식포괄쌍측갑상선대부절제술(31례)、환측전절대측대부절제화구역성림파결청소술(6례)、쌍측전절급림파결청소술(11례).술전초성진단양성솔위61.3%,갑상선핵소현상적진단양성솔위62.5%;48례환자중획수방40례,시간1～264개월,중위수방시간130.5개월.수방중무갑상선공능항진복발병례,2례환자술후제이년출현폐、골전이.결론 초성검사화핵소현상대우술전진단유중요의의,갑상선공능항진합병갑상선은닉암화미소암적림상진단교곤난,다우수술후병리진단.갑상선공능항진합병갑상선유두상암적환자수술치료효과량호,예후교호.
Objective To evaluate the diagnosis and surgical treatment of primary hyperthyroidism concurrent with thyroid carcinoma.Methods The clinical data 48 cases with hyperthyroidism complicating with thyroid carcinoma,confirmed by pathology in Peking Union Medical College Hospital from January 1983 to July 2009 was retrospectively analyzed.Results The incidence of thyroid carcinoma was 2.02% (48/2378) in hyperthyroidism,and the incidence of hyperthyroidism was 3.03% (48/1584) in thyroid carcinoma.The diagnostic accuracy of ultrasound and radionuclide imaging were 61.3%and 62.5% respectively.Thyroidectomy was performed in 48 patients (37 women and 9 men),including 43 papillary carcinomas,4follicular carcinomas and 1 follicular papillary carcinomas.Subtotal thyroidectomy (31 patients),homolateral total thyroidectomy and contralateral subtotal thyroidectomy with neck dissection (6 patients),and total thyroidectomy with neck dissection or radical neck dissection (11 patients) were performed.Lung metastasis and bone metastasis were found in 2 cases in the second year after surgery.40 cases were followed up from 1 to 264 months (mean 130.5 months) postoperatively and there was no hyperthyroidism recurrence.Conclusions The diagnosis of occult thyroid cancer complicated with hyperthyroidism is very difficult,most of which were diagnosed by pathology.Ultrasound and radionuclide imaging are of much importance for the establishment of diagnosis.The postoperative prognosis of thyroid papillary carcinoma complicated with hyperthyroidism is satisfactory.