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目的:探讨结节性甲状腺肿并存甲状腺癌时的临床特征、治疗和预后。方法:回顾性分析1991年1月～2000年12月经手术治疗的结节性甲状腺肿合并有甲状腺癌的临床资料。结果:同期中,共手术治疗结节性甲状腺肿3955例中,内25例合并甲状腺癌(0.63%)。男6例,女19例,年龄12～65(36.8±13.1)岁。12例为微小的甲状腺乳头状癌,12例为乳头状甲状腺癌,1例为滤泡状甲状腺癌。有颈淋巴结转移者4例,3例位于颈侧,1例位于气管前。术前和术中诊断出甲状腺癌者占32%,术后病理检查时发现的为68%。术后随访10个月～10年,2例因颈淋巴结肿大而再次手术治疗,1例为甲状腺癌淋巴结转移,1例为淋巴结反应性增生。结论:结节性甲状腺肿合并甲状腺癌者预后较好。一方面,不应简单地认为结节性甲状腺肿是良性病变,而忽略同时存在恶性结节的可能性;另一方面,也不应过分强调甲状腺癌存在于结节性甲状腺肿中的可能性而随意放宽手术指征,或扩大手术范围。
Objective: To investigate the clinical features, treatment and prognosis of patients with nodular goiter complicated with thyroid cancer. Methods: A retrospective analysis of January 1991 to December 2000 surgically treated nodular goiter with thyroid cancer clinical data. Results: During the same period, among the 3955 cases with nodular goiter, 25 cases had thyroid cancer (0.63%). 6 males and 19 females, aged from 12 to 65 (36.8 ± 13.1) years old. Twelve cases were microscopic thyroid papillary carcinoma, 12 cases papillary thyroid carcinoma and 1 case follicular thyroid carcinoma. There were 4 cases of cervical lymph node metastasis, 3 cases located in the neck side, 1 case located in front of the trachea. Preoperative and intraoperative diagnosis of thyroid cancer accounted for 32%, postoperative pathological examination found that 68%. The patients were followed up for 10 months to 10 years. Two cases were treated by reoperation due to cervical lymph node enlargement. One case had lymph node metastasis of thyroid carcinoma and one case had reactive lymph node hyperplasia. Conclusion: Nodular goiter with thyroid cancer has a good prognosis. On the one hand, nodular goiter should not simply be regarded as a benign lesion, while ignoring the possibility of malignant nodules; on the other hand, the possibility of thyroid cancer in nodular goiter should not be overemphasized And feel free to relax the indications, or to expand the scope of surgery.