慢性淋巴细胞性甲状腺炎合并甲状腺乳头状癌的外科诊疗
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摘要
目的探讨慢性淋巴细胞性甲状腺炎(CLT)合并甲状腺乳头状癌(PTC)的临床诊断及治疗。方法回顾性分析2014年8月至2016年6月安徽医科大学第二附属医院收治的36例CLT合并PTC患者的临床资料。结果 36例患者中,有22例(61. 1%)存在多发结节,21例(58. 3%)位于双侧; 9例(25. 0%)存在多发癌灶,4例(11. 1%)位于双侧。32例患者行中央区或联合颈侧区淋巴结清扫术,17例(53. 1%)存在中央区转移淋巴结。结论 CLT合并的PTC有多灶性特点,手术方式建议行甲状腺全/近全切除术,少数患者可行单侧腺叶+峡部切除;建议常规清扫中央区淋巴结,慎重选择清扫颈侧区淋巴结。
Objective To investigate the diagnosis and treatment of chronic lymphocytic thyroiditis( CLT) combined with papillary thyroid carcinoma( PTC). Methods The clinical data of 36 patients diagnosed as CLT combined with PTC were retrospectively analyzed.Results Twenty-two( 61. 1%) of the 36 patients had multiple nodules,21( 58. 3%) were bilateral; 9( 25. 0%) were multiple cancer foci,and 4( 11. 1%) were bilateral. Thirty-two patients underwent central or combined lateral cervical lymphadenectomy,and 17( 53. 1%)had positive central lymph nodes. Conclusion The CLT combined PTC has multifocal characteristics. Total/near total thyroidectomy is recommended. Unilateral lobectomy plus isthmus resection is feasible for some patients. The dissection of central lymph node dissection is recommended,and the selectionshould be carefulfor the lateral cervical lymph nodedissection.
Objective To investigate the diagnosis and treatment of chronic lymphocytic thyroiditis( CLT) combined with papillary thyroid carcinoma( PTC). Methods The clinical data of 36 patients diagnosed as CLT combined with PTC were retrospectively analyzed.Results Twenty-two( 61. 1%) of the 36 patients had multiple nodules,21( 58. 3%) were bilateral; 9( 25. 0%) were multiple cancer foci,and 4( 11. 1%) were bilateral. Thirty-two patients underwent central or combined lateral cervical lymphadenectomy,and 17( 53. 1%)had positive central lymph nodes. Conclusion The CLT combined PTC has multifocal characteristics. Total/near total thyroidectomy is recommended. Unilateral lobectomy plus isthmus resection is feasible for some patients. The dissection of central lymph node dissection is recommended,and the selectionshould be carefulfor the lateral cervical lymph nodedissection.
引文
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[12]王蕴珺,吴毅,王卓颖,等.单侧甲状腺乳头状癌对侧中央区淋巴结转移的相关危险因素[J].外科理论与实践,2014,19(3):214-218.
[2] OHMORI N,MIYAKAWA M,OHMORI K,et al. Ultrasonographic findings of papillary thyroid carcinoma with Hashimoto's thyroiditis[J]. Intern Med,2007,46(9):547-550.
[3]代妮娜,张文君.桥本氏甲状腺炎合并结节样病变的超声影像特征分析[J].安徽医学,2016,37(8):988-992.
[4]陈诚,余宁康,龚进发,等.桥本甲状腺炎合并甲状腺乳头状癌的临床特点及外科治疗[J].中华普通外科杂志,2013,28(7):511-514.
[5] KONTUREK A,BARCZYńSKI M,NOWAK W,et al. Risk of lymph node metastases in multifocal papillary thyroid cancer associated with Hashimoto's thyroiditis[J]. Langenbecks Arch Surg,2014,399(2):229-236.
[6] HAUGEN B R,ALEXANDER E K,BIBLE K C,et al.2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer[J]. Thyroid,2016,26(1):1-133.
[7] ADAM M A,PURA J,GU L,et al. Extent of surgery for papillary thyroid cancer is not associated with survival:an analysis of 61775 patients[J]. Ann Surg,2014,260(4):601-607.
[8] NOURELDINE S I,TUFANO R P. Association of Hashimoto's thyroiditis and thyroid cancer[J]. Curr Opin Oncol,2015,27(1):21-25.
[9] ANAND A,SINGH K R,KUSHWAHA J K,et al. Papillary thyroid cancer and Hashimoto's thyroiditis:an association less understood[J]. Indian J Surg Oncol,2014,5(3):199-204.
[10] ZHANG Y,DAI J,WU T,et al. The study of the coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma[J]. J Cancer Res Clin Oncol,2014,140(6):1021-1026.
[11]高明,葛明华,嵇庆海,等.甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版)[J].中国肿瘤临床,2016,43(10):405-411.
[12]王蕴珺,吴毅,王卓颖,等.单侧甲状腺乳头状癌对侧中央区淋巴结转移的相关危险因素[J].外科理论与实践,2014,19(3):214-218.