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本文总结了1985~1992年因甲状腺肿块入院手术治疗者213例。其中男41例,女172例;良性病变202例,恶性病变11例。良性病例中行腺瘤摘除178例,腺叶切除23例,腺叶及峡部切除1例。恶性病例中行甲状腺次全切除6例,腺叶切除加颈部淋巴结清除者3例。对甲状腺结节鉴别其良、恶性具有重要意义,它关系到手术方式的选择。目前,对该病的诊断除病史、体检外,可应用B超、I扫描、细针抽吸活检(FNAB),以及术中冰冻切片(FS)等检查,其中FNAB检查日趋广泛,因它具有简易、安全、费用低、准确性高等特点。本组检查40例与术后病理切片对照,诊断符合率92%,但可出现假阳性或假阴性,可用专人抽吸、看片、反复穿刺等提高诊断符合率。甲状腺结节的治疗以手术切除为首选方法,但对切除范围有一定分歧,本组对良性病变多采取腺瘤摘除术或腺叶切除术,术后损伤小,无一例发生神经损伤、窒息等并发症,病人术后恢复快。对恶性病变行根治术手术。确有怀疑的病例,应在手术中充分显露患侧部位,对侧也应扪诊检查,进行肉眼观察,必要时做冰冻切片,根据病理类型选择相应的手术。
This article summarizes 213 cases of thyroid masses admitted to hospital for treatment from 1985 to 1992. There were 41 males and 172 females; there were 202 benign lesions and 11 malignant lesions. In benign cases, 178 adenomas were removed, 23 were glandular lobectomy, and 1 was glandular lobe and isthmus resection. In malignant cases, 6 cases underwent subtotal thyroidectomy, and 3 cases underwent lobectomy and neck lymph node dissection. It is of great significance to differentiate benign and malignant thyroid nodules. It is related to the choice of surgical methods. At present, besides the diagnosis of the disease, in addition to medical history and physical examination, B-ultrasonography, I-scanning, fine-needle aspiration biopsy (FNAB), and intraoperative frozen section (FS) examinations can be applied, among which FNAB examination is becoming more and more popular because it has Simple, safe, low cost, high accuracy. In this group, 40 cases were compared with postoperative pathological sections. The diagnostic coincidence rate was 92%, but false positives or false negatives may occur. The rate of diagnosis coincidence may be increased by aspiration, viewing, and repeated puncture. The treatment of thyroid nodules by surgical resection is the preferred method, but there are certain differences in the scope of resection. This group of patients with benign lesions take adenoma or lobectomy, after surgery, the injury is small, no cases of nerve damage, asphyxia, etc. Complications, patients recover faster after surgery. Radical surgery for malignant lesions. In cases where there are doubts, the affected part should be fully revealed in the operation, and the contralateral side should also be examined by percussion. The naked eye should be observed. If necessary, frozen sections should be made. Select the appropriate operation according to the pathological type.