CAJ | 학술논문

目的：总结原发性甲状腺恶性淋巴瘤（PTL）的临床表现、诊断、治疗和预后情况。方法回顾性分析我院2009年至2012年收治的22例PTL患者的临床和病理资料。22例患者均接受手术治疗，术中查8例病变局限于腺体内，14例侵及腺外组织。其中行甲状腺全切1例，双侧次全切除15例，单侧腺叶切除6例，3例同期行中央区淋巴结清扫术。6例患者因术前有气道狭窄在手术同期行气管切开术。结果22例患者术后病理证实为PTL。实验室检查均有甲状腺球蛋白抗体和／或微粒体抗体升高。病理类型为弥漫性大B细胞淋巴瘤（DLBCL型）和黏膜相关淋巴组织淋巴瘤（MALT型）。术后化疗效果良好。最长随访时间61个月。结论 PTL诊断较难，术后病理检查是明确诊断的有效方法。对于迅速增大并伴有压迫症状及抗体增高的甲状腺肿物术前应考虑PTL的可能性，并予以积极处理。甲状腺抗体检查在协助诊断上有一定意义。联合放化疗是临床上治疗的主要方法。两种病理类型淋巴瘤的患者在预后上未见明显差异。
목적：총결원발성갑상선악성림파류（PTL）적림상표현、진단、치료화예후정황。방법회고성분석아원2009년지2012년수치적22례PTL환자적림상화병리자료。22례환자균접수수술치료，술중사8례병변국한우선체내，14례침급선외조직。기중행갑상선전절1례，쌍측차전절제15례，단측선협절제6례，3례동기행중앙구림파결청소술。6례환자인술전유기도협착재수술동기행기관절개술。결과22례환자술후병리증실위PTL。실험실검사균유갑상선구단백항체화／혹미립체항체승고。병리류형위미만성대B세포림파류（DLBCL형）화점막상관림파조직림파류（MALT형）。술후화료효과량호。최장수방시간61개월。결론 PTL진단교난，술후병리검사시명학진단적유효방법。대우신속증대병반유압박증상급항체증고적갑상선종물술전응고필PTL적가능성，병여이적겁처리。갑상선항체검사재협조진단상유일정의의。연합방화료시림상상치료적주요방법。량충병리류형림파류적환자재예후상미견명현차이。
Objective To investigate clinical manifestations,diagnosis,treatment and prognosis ofprimary thyroid lymphoma(PTL).Methods The clinical data of 22 PTL cases admitted to our hospitalfrom 2009 to 2012 were reviewed retrospectively.All patients received surgical treatment,including 8 caseswith limited lesion confined to the gland and 14 cases with extragland invasions.There were 1 case of totalthyroidectomy,15 cases of bilateral subtotal thyroidectomy and 6 cases of unilateral gland lobectomy.At thesame time,three patients received central lymph node dissection and six patients received tracheotomy forpreoperative airway stenosis.Results Postoperative pathology confirmed the diagnosis of PTL in all cases.Laboratory tests showed elevation of thyroglobulin antibodies and(or)microsomal antibodies in all cases.Pathological types included diffuse large Bcell lymphoma(DLBCL)and mucosalassociated lymphoid tissue(MALT)lymphoma.Patients showed good prognosis after postoperative chemotherapy.The longest followup time was 61 monthsConclusion Diagnosing of PTL is difficult and postoperative pathologic examination is an effective diagnostic method.If a patient presented as a rapidly growing thyroid nodule associated with oppression symptoms and increasing antibody level,surgeons should consider the possibility of PTLpreoperatively and deal with it actively.Thyroid antibody levels have significance in assisting diagnosis.Combined chemoradiotherapy is the main method for PTL.There is no significant difference in prognosisbetween patients with the two pathological types of PTL.