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目的探讨桥本病并发甲状腺癌的诊断及手术方法。方法回顾1982年1月至2003年12月109例桥本病中同时并存甲状腺癌11例的病例资料,对其术前检查、诊断及治疗进行分析研究。结果桥本病与甲状腺癌并发率为10%(11/109),甲状腺癌术前确诊率46%(7/15);均经手术治疗。局部复发2例、转移2例、经再次手术均存活。5、10年生存率分别为63%(7/11)和57%(4/7),3例死于远处转移。术后甲状腺机能减退3例,一侧声带麻痹1例,低钙抽搐2例。结论桥本病并发甲状腺癌术前确诊率低,病史、细针针吸活检、CT等综合分析有利于术前诊断,手术是其最有效的治疗方法。
Objective To investigate the diagnosis and surgical treatment of Hashimoto’s thyroiditis complicated with thyroid cancer. Methods From January 1982 to December 2003, 109 patients with Hashimoto’s thyroiditis were enrolled in this study. The data of 11 cases were retrospectively analyzed. The preoperative examination, diagnosis and treatment were analyzed. Results The incidence of Hashimoto’s thyroiditis and thyroid cancer was 10% (11/109), and the preoperative diagnosis rate of thyroid cancer was 46% (7/15). All patients were surgically treated. Local recurrence in 2 cases, 2 cases of metastasis, survived by reoperation. The 5-year and 10-year survival rates were 63% (7/11) and 57% (4/7), respectively. Three patients died of distant metastasis. Postoperative hypothyroidism in 3 cases, one case of vocal cord paralysis in one case, low calcium convulsions in 2 cases. Conclusions The preoperative diagnosis rate of Hashimoto’s thyroiditis complicated with thyroid cancer is low, and the comprehensive analysis of history, fine needle aspiration biopsy and CT is helpful for the preoperative diagnosis. Surgery is the most effective treatment method.