结节性甲状腺肿合并甲状腺癌的临床诊治分析

摘要

Objective:To evaluate the diagnosis and treatment in nodular goiter association with thyroid cancer.Methods:The clinical data of 54 cases nodular goiter association with thyroid cancer,confirmed by pathology in The General Hospital of PLA Hainan Branch from June 2012 to June 2015 was analyzed.Results:The incidence of thyroid cancer was 14.9%(54/362) in nodular goiter.The diagnostic accuracy of ultrasound was 61.1%.Homolateral total thyroidectomy and contralateral subtotal thyroidetomy with neck dissection (36 cases),and total thyroidectomy and lsthmus (18 cases) were performed.1 case was found lung metastasis in the second year after surgery,3 cases neck metastasis operate again.48 cases were followed up from 3 to 36 months postoperative.Conclusion:Ultrasound and fine needle aspiration cytology are much importance for the establishment of diagnosis.The diagnosis of occult thyroid cancer complicated with nodular goiter is very difficult,most of which were diagnosed by pathology.The postoperative prognosis of nodular goiter association with thyroid cancer is satisfactory.%目的:探讨结节性甲状腺肿合并甲状腺癌的诊断和治疗方法.方法:分析我院从2012年6月至2015年6月收治的经外科手术及病理证实的54例结节性甲状腺肿合并甲状腺癌患者的临床资料.结果:结节性甲状腺肿合并甲状腺癌占同期结节性甲状腺肿患者的14.9%(54/362).术前超声诊断阳性率为61.1%(33/54).手术方式包括患侧甲状腺全切除+峡部切除+对侧甲状腺部分切除+同侧淋巴结清扫(36例),患侧甲状腺全切+峡部切除(18例).54例患者中获随访48例,时间3月~36月,3例因颈部淋巴结肿大再次手术治疗,1例术后2年出现肺部转移.结论:超声检查对于术前诊断有重要意义,结合术前细针穿刺细胞学检查可进一步提高术前诊断率,结节性甲状腺肿合并甲状腺微小癌的临床诊断较困难,多于手术后病理诊断.结节性甲状腺肿合并甲状腺乳头状癌的患者手术治疗效果良好,预后较好.