桥本病合并甲状腺肿瘤的外科治疗和临床特征分析

摘要

Background and purpose: The incidence of Hashimoto's disease (HD) coexistent with thyroid carcinoma is 0.5%-38%, and it is increased significantly in recent years. Therefore, we investigated the clinical characteristics and surgical experiences in patients with HD coexistent with thyroid neoplasm. Methods: The clinical data in 417 cases of HD coexistent with thyroid nodules including 93 cases of HD coexistent with thyroid carcinoma treated surgically and confirmed pathologically from Jun. 1985 to Dec. 2007 were analyzed. Results: The coexistent rate of HD with thyroid carcinoma (TC) was 22.3% respectively. The coexistent rate of HD with TC was 9.2% before 1995, and it went up to 24.7% after that year (P<0.05). Among those HD coexistent with TC patients, 66 cases were papillary carcinoma, 15 cases were follicular carcinoma, 9 cases were mixture and 3 cases were lymphoma. There were 43 cases of micro-foci thyroid carcinoma, which accounted for 46.2% of the malignancy. Unilateral or bilateral, total, subtotal or partial thyroidectomy and biopsy were the main operative procedures for the disease. Conclusion: There is a high incidence of thyroid carcinoma in patients with HD coexistent with thyroid nodules, and it is rising up recently. In the clinical treatment of HD, we should be aware of the coexistent thyroid tumors and micro-foci thyroid carcinoma.%背景与目的:桥本病(Hashimoto's disease,HD)并存甲状腺癌(thyroid careinoma,TO的发病率在0.5%～38.0%之间,近年来呈显著上升趋势.基于上述原因,本研究旨在探讨HD合并甲状腺肿瘤的临床特征和外科诊治经验.方法:对本院1985年1月-2007年12月收治的因甲状腺结节行外科手术后经病理证实为HD的417例患者(包括93例HD合并TC患者)的临床资料进行分析.结果:与HD并存TC患者共93例,占22.3%;1995年以前HD与TC并存患者6例,占同期手术治疗HD病例的9.2%(6/65);1995年以后HD与TC并存患者87例,占同期手术治疗HD病例的24.7%(87/352),差异有显著性(P<0.05).并存TC病例中乳头状癌66例,滤泡状癌15例,混合性癌9例,黏膜相关淋巴瘤3例;全组中微灶癌43例,占并存TC病例的46.2%(43/93).手术方式包括一侧或双侧甲状腺全切除或次全切除、部分切除和活检术.结论:HD并存甲状腺结节的病例中TC的发病率近年来有明显增高趋势,临床上应警惕并存TC特别是微灶癌的可能性.