甲状腺结核的诊断和治疗

摘要

目的探讨甲状腺结核的诊断与治疗。方法对48例经手术和病理证实的甲状腺结核进行回顾性分析。结果术前大多数误诊为甲状腺腺瘤，少数诊断为甲状腺癌、甲状腺炎，偶有怀疑本病者。病灶切除32例，腺叶切除6例，双侧次切4例，颈清3例，峡部切除3例，切排引流3例。抗痨治疗9～12个月治愈。随访1～22年，未见复发。结论针刺细胞学检查有助于甲状腺结核的诊断。治疗首选药物抗痨。对弥漫性肿大性质未定者可行峡部切除，干酪型周围已形成脓肿者，可行脓肿切排引流，术后用抗结核药局部灌洗。%Objective　To summarize the diagnosis and treatment of thyroid tuberculosis.Methods　Retrospectively analyze 48 cases with thyroid tuberculosis confirmed by pathology received surgical operation. Results Before the surgical operation, the mojority of cases were misdiagnosed as thyroid adenoma, the minority were misinterpreted as thyroid carcinoma or thyroiditis, and few cases were suspected as thyroid tuberculosis. Performed local excision in 32 cases, unilateral thyroid lobectomy in 6 cases, bilateral subtotal thyroidectomy in 4 cases, isthmectomy in 3 cases and incision & drainage in 3 cases. In addition, also performed neck dissection in 3 cases. All the patients were treated with anti-tuberculosis drugs for 9 to 12 months and were recovered. All the patients were followed up for 1 to 22 years and didn't recur. Conclusion　Cytological examination by fine-needle aspirate biopsy was helpful to diagnosis. The first choice was treatment with anti-tuberculosis drugs. To the diffuse enlargement of the thyroid could perform incision & drainage, and after the operation could irrigate the lesion with anti-tuberculosis drugs.