【摘要】 目的:探讨近年来桥本甲状腺炎并发甲状腺乳头状癌的发病特点和外科治疗方法,来提高对该病诊断和治疗的认识。方法:回顾性分析2008-2013年天津医科大学第四中心临床学院手术切除的,且均有病理证实的单纯桥本甲状腺炎(HT)208例,桥本甲状腺炎(HT)并发甲状腺乳头状癌(PTC)52例,通过对照比较其年龄、病程、肿物体征、彩超特点、促甲状腺激素(TSH)指标及外科治疗方式与效果,总结分析HT并发PTC的高危特征与预后特点。结果:HT并发PTC占同期260例经病理证实为HT病例的20%(52/260)。两者比较,HT并发PTC年龄偏大,病程较长,TSH增高者多;结节样肿大较弥漫性肿大者癌变率高,彩超砂粒样微钙化发生率高,差异均具有统计学意义(P<0.05)。经外科手术治疗后发现HT并发PTC患者临床分期较早,淋巴结转移率偏低、复发率低,术后甲低率较高。结论:HT并发PTC的发生率呈上升趋势;对于病程长合并TSH增高明显,甲状腺结节状增大的中年女性桥本甲状腺炎患者,如内科治疗效果欠佳,定期复查彩超提示肿物内砂粒样钙化者,可作为筛选癌变的高危特征;经外科治疗后HT并发PTC的愈后较好。更多还原

【Abstract】 Objective:To study the clinical characteristics and surgical treatment of Hashimoto’s thyroiditis with papillary thyroid cancer in recent years,to improve understanding of the disease diagnosis and treatment.Methods:a retrospective analysis of Fourth Central Hospital of Tianjin Medical University 2008to 2013operation excision,and all have the pathology of pure Hashimoto thyroiditis(HT)in 208cases,Hashimoto’s thyroiditis(HT)patients coexisted with papillary thyroid cancer(PTC)in 52cases,by comparison of their age,course of disease,tumor,ultrasound characteristics of signs,thyroid stimulating hormone(TSH)index and the surgical treatment method and effect,summarizes the characteristics and prognosis of high-risk characteristics analysis of HT coexisted with PTC.Results:HT coexisted with PTC accounted for 20%(52/260)the same period in 260patients with pathologically confirmed cases of HT.By comparison,HT coexisted with PTC,older age,longer course,TSH level is higher;canceration rate of nodular enlargement is higher than diffuse enlargement,ultrasound sand-like micro-calcification rate is higher,the differences were statistically significant(P<0.05).After the surgical operation treatment,we find the clinical stage is earlier,lymph node metastasis rate is low,the recurrence rate is low,and a higher rate of postoperative hypothyroidism.Conclusion:The incidence of HT coexisted with PTC is rising;for long course with TSH increased significantly,middle-aged women patients of Hashimoto’s thyroiditis with thyroid nodular enlargement,such as poor treatment of internal medicine,ultrasound intratumoral sand-like micro-calcification,can be used as a screening high-risk characteristics of cancer.After surgical treatment,the prognosis of patients are better in HT coexisted with PTC.更多还原