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目的 探讨桥本病合并甲状腺恶性肿瘤的临床发病关系及其诊断、治疗和预后。方法 回顾 1984～2 0 0 1年 138例桥本病合并甲状腺恶性肿瘤 19例 ,结合文献进行临床分析。结果 发病率为 13 77% ( 19/ 138)。其中桥本病合并甲状腺癌 17例 ,发病率为 12 32 % ,合并淋巴瘤 2例 ,发病率为 1 45 %。全组病人均出现甲状腺结节 ,经手术治疗后并随访淋巴瘤死亡 1例 ,甲状腺癌 17例随访无死亡及复发 ,预后好。结论 对于合并甲状腺结节的桥本病应考虑手术治疗。桥本病合并甲状腺恶性肿瘤临床诊断较困难。术前常规测血TGA、MCA、甲状腺核素显影、细针穿刺、术中快速冰冻切片 ,有利于术前、术中确诊及正确的手术方式选择。
Objective To investigate the relationship between Hashimoto’s disease and thyroid malignant tumor, its diagnosis, treatment and prognosis. Methods From 1984 to 2001, 138 cases of Hashimoto’s disease with 19 cases of thyroid malignant tumor were retrospectively analyzed, and the clinical data were analyzed. The incidence rate was 13 77% (19/138). Hashimoto’s disease with thyroid cancer in 17 cases, the incidence was 12 32%, 2 cases of lymphoma combined, the incidence was 1 45%. Thyroid nodules were found in all the patients. One patient was followed up for lymphoma after operation and 17 patients with thyroid carcinoma were followed up without death and recurrence. The prognosis was good. Conclusions Surgery should be considered for Hashimoto’s disease with thyroid nodules. Hashimoto’s disease complicated with thyroid cancer is more difficult to diagnose. Preoperative routine blood test TGA, MCA, thyroid nuclide imaging, fine needle aspiration, intraoperative rapid frozen section, is conducive to preoperative and intraoperative diagnosis and the correct choice of surgical approach.