慢性淋巴细胞性甲状腺炎合并甲状腺结节的诊疗分析
摘要
目的探讨慢性淋巴细胞性甲状腺炎(CLT)合并甲状腺结节的外科诊断与治疗。方法回顾性分析该院手术治疗的41例CLT合并甲状腺结节的患者临床资料。结果 41例患者中20例为恶性,21例为良性。恶性结节的超声特征为低回声、微钙化、形态不规则及边界不清楚(P<0.05);恶性结节在有微小钙化或粗大钙化结节中的构成比差异无统计学意义(P>0.05);超声诊断恶性结节的ROC下曲线面积为0.688(P=0.010)。结论良性结节应保证手术的彻底性,至少行单侧腺叶切除;恶性结节应该坚持手术的根治性,至少行单侧腺叶联合峡部切除,并清扫中央区淋巴结,慎重选择清扫颈侧区淋巴结。
引文
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[3]杨雯雯,李青,卢雪玲,等.甲状腺良,恶性结节的多普勒超声检查结果分析[J].重庆医学,2015,44(24):3403-3405.
[4] 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.
[5]张伟,朱亚,吴海燕,等.甲状腺超声影像报告和数据系统分类在良恶性甲状腺结节鉴别诊断中的应用价值[J].广西医学,2016,38(3):345-347.
[6] BAKKAR S,POMA A M,CORSINI C A,et al.Underestimated risk of cancer in solitary thyroid nodules≥3cm reported as benign[J].Langenbecks Arch Surg,2017,402(7):1089-1094.
[7]周晓倩,金慧,郑淼,等.合并桥本甲状腺炎的甲状腺乳头状癌术式探讨[J].中华普通外科杂志,2016,31(3):236-237.
[8] DELRIO P,PISANI P,MONTANA C M,et al.The surgical approach to nodule Thyr 3-4after the 2.2014NCCN and2015ATA guidelines[J].Int J Surg,2017,41(1):21-25.
[9] YC K,DEGROOT L J.Painful hashimoto′s thyroiditis as anindicationforthyroidectomy:clinical characteristics and outcome in seven patients[J].J Clin Endocrinol Metab,2003,88(6):2667-2672.
[10]ADAM M A,PURA J,GU L,et al.Extent of surgery for papillary thyroid cancer is not associated with survival:an analysis of 61 775patients[J].Ann Surg,2014,260(4):601-605.
[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.
[13]王海岭,王云峰,金照凯.颈部淋巴结选择性清扫对甲状腺癌患者的临床应用观察[J].安徽医药,2015,19(1):140-141.
[14]徐震纲,刘绍严,朱一鸣.分化型甲状腺癌颈侧区淋巴结清扫术若干问题[J].中国实用外科杂志,2017,37(9):941-943.