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目的探讨结节型桥本氏甲状腺炎的诊断、手术适应证及术式选择。方法资料来源于2005年1月至2014年1月在我院接受诊治的415例桥本氏甲状腺炎的完整病案病例。诊断方法通过检测甲状腺抗体;超声、CT查、同位素扫描;细针或粗针穿刺活检联合检查。所有患者均表现为甲状腺结节而进行手术治疗,根据患者结节的病变范围,主要采取甲状腺全切、患侧腺叶+峡部切除及双侧腺叶次全切除术进行治疗。结果 415例中:单纯桥本氏甲状腺炎157例,桥本氏甲状腺炎合并毒性甲状腺肿18例,合并结节性甲状腺肿146例,合并甲状腺腺瘤31例,合并甲状腺癌63例。结论桥本氏甲状腺炎临床表现缺乏特异性,应采用采取多种检查手段提高诊断的准确性,避免手术不必要手术,但疑有恶变或产生压迫症状者应积极手术。以往诊断出现结节即采取手术的方法不符合当前治疗指南。
Objective To investigate the diagnosis, surgical indications and operative choice of nodular Hashimoto’s thyroiditis. Method information from January 2005 to January 2014 in our hospital for diagnosis and treatment of 415 cases of Hashimoto’s thyroiditis complete case record. Diagnostic methods by detecting thyroid antibodies; ultrasound, CT scan, isotope scan; fine needle or thick needle biopsy joint examination. All patients showed thyroid nodules for surgical treatment. According to the range of patients’ nodules, total thyroidectomy, ipsilateral ipsilateral lobe and isthmic resection and subtotal lobectomy were performed. Results Among the 415 cases, 157 were Hashimoto’s thyroiditis, 18 Hashimoto’s thyroiditis with toxic goiter, 146 with nodular goiter, 31 with thyroid adenoma and 63 with thyroid cancer. Conclusion The clinical manifestations of Hashimoto’s thyroiditis are lack of specificity. Various diagnostic methods should be taken to improve the diagnostic accuracy and avoid unnecessary surgery. However, patients with malignant or oppressive symptoms should be actively treated. Past diagnosis of nodules that take surgery does not meet the current treatment guidelines.