合并桥本氏甲状腺炎的甲状腺癌外科治疗

李磊; 杨洁; 王伟霖; 王虎

合并桥本氏甲状腺炎的甲状腺癌外科治疗

云南省肿瘤医院病理科

基金项目:

基金：云南省卫生科技计划资助项目 (2012WS0035);

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出版历程
- 收稿日期: 2017-04-21

Surgical Treatment Strategy of Thyroid Carcinoma with Hashimoto's Thyroiditis

Funds:

基金：云南省卫生科技计划资助项目 (2012WS0035);

摘要

摘要: 目的探讨甲状腺乳头状癌 (papillary thyroid carcinoma, PTC) 合并桥本氏甲状腺炎 (hashimoto’s thyroiditis, HT) 的临床特点及手术策略.方法回顾性分析334例PTC患者以及其中合并HT的患者临床病理资料.结果单纯PTC组 (252例) , PTC合并HT组 (82例) , 所有患者均行手术治疗, 根据患者病情分别行腺叶+峡部切除、全切或近全切除以及不同范围的颈淋巴结清扫术, 术后病理证实为PTC.与单纯PTC组比较, PTC合并HT组中女性所占比、单叶受累、颈淋巴结阴性比率均明显增加, 而病灶最大径明显减小 (P<0.05) .发现单纯PTC组较PTC+HT组有更高的中央区淋巴结转移率 (P=0.001) , HT合并PTC组发生术后低钙的比率明显增高.结论甲状腺乳头状癌 (PTC) 合并桥本氏甲状腺炎以女性多见, HT可能对PTC原发灶的外侵、腺体内及颈部淋巴结转移有一定的抑制作用, 合并HT的甲状腺癌手术术后并发症增加, 值得引起注意.
- 甲状腺癌 /
- 桥本氏甲状腺炎 /
- 甲状腺手术
Abstract: Objective To investigate the clinical characteristics and surgical strategies of papillary thyroid carcinoma (PTC) combined with Hashimoto 's thyroiditis (HT) . Methods The retrospective study was performed in 82 patients of PTC with HT patients among 334 PTC patients. Results The results showed that all patients underwent surgical treatment. According to the patient's condition, we performed glandular and isthmus resection, total or near total resection and different range of cervical lymph node dissection. The postoperative pathology confirmed as PTC. Compared with the PTC group, the female in PTC+HT group's cervical lymph node negative ratio was significantly increased, and the maximum diameter of the lesion was significantly reduced (all P<0.05) . The rate of transient hypocalcemia was significantly higher in PTC+HT group than that in the PTC group (P <0.01) . Conclusions PTC combined with HT is more common in women. HT may have a certain inhibitory effect on the invasion of PTC primary tumor and lymph node metastasis. Surgery in PTC+HT may have higher incidence of complications which should be paid more attention to.
- Papillary thyroid carcinoma /
- Hashimoto's thyroiditis /
- Thyroid surgery

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参考文献(17)

[1]	[1]SLIJEPCEVIC N, ZIVALJEVIC V, MARINKOVIC J, et al.Retrospective evaluation of the incidental finding of 403papillary thyroid microcarcinomas in 2466 patients undergoing thyroid surgery for presumed benign thyroid disease[J].BMC Cancer, 2015, 15 (1) :330.
[2]	[2]KONTUREK A, BARCZYSKI M, NOWAK W, et al.Risk of lymph node metastases in multifocal papillary thyroid cancer associated with Hashimoto's thyroiditis[J].Langenbecks Arch Surg, 2014, 399 (2) :229-236.
[3] 吴毅.甲状腺结节和分型甲状腺癌诊疗指南热点解读[J].中华内分泌外科杂志, 2012, 6 (1) :1-2.
[4]	[4]CATUREGLI P, DE REMIGIS A, CHUANG K, et al.Hashimoto's thyroiditis:Celebrating the centennial through the lens of the johns hopkins hospital surgical pathology records[J].Thyroid, 2013, 23 (2) :142-150.
[5]	[5] OH C M, PARK S, LEE J Y, et al.Increased prevalence of chronic lymphocytic thyroiditis in Korean patients with papillary thyroid cancer[J].PLo S One, 2014, 9 (6) :e99054.
[6]	[6] KONTUREK A, BARCZYSKI M, NOWAK W, et al.Risk of lymph node metastases in multifocal papillary thyroid cancer associated with Hashimoto’s thyroiditis[J].Langenbecks Arch Surg, 2014, 399 (2) :229-236.
[7]	[7]PARK J Y, KIM D W, PARK H K, et al.Comparison of T stage, N stage, multifocality, and bilaterality in papillary thyroid carcinoma patients according to the presence of coexisting lymphocytic thyroiditis[J].Endocr Res, 2015, 40 (3) :151-155.
[8]	[8]PITZALIS C, JONES G W, BOMBARDIERI M, et al.Ectopic lymphoid-like structures in infection, cancer and autoimmunity[J].Nat Rev Immunology, 2014, 14 (7) :447-462.
[9]	[9]TOMER Y.Genetic susceptibility to autoimmune thyroid disease:past, present, and future[J].Thyroid, 2010, 20 (7) :715-725.
[10]	[10]OH C M, PARK S, LEE J Y, et al.Increased prevalence of chronic lymphocytic thyroiditis in korean patients with papillary thyroid cancer[J].PLo S One, 2014, 9 (6) :e99054.
[11]	[11]ANAND A, SINGH K R, KUSHWAHA J K, et al.Papillary thyroid can-cer and Hashimoto's thyroiditis:An association less understood[J].Indian J Surg Oncol, 2014, 5 (3) :199-204.
[12]邹秀和, 孙映荷, 朱信心, 等.2000~2012年期间华西医院甲状腺疾病构成的变化分析[J].中国普外基础与临床杂志, 2013, 20 (9) :987-991.
[13]张广, 边学海, 李世杰, 等.甲状腺炎合并甲状腺癌210例诊治分析[J].中国实用外科杂志, 2011, 31 (6) :525-526, 529.
[14]	[14]FISH E N.The X-files in immunity:sex-based differences predispose immune responses[J].Nature Reviews Immunology, 2008, 8 (9) :737-740.
[15]	[15]ZHANG Y, DAI J, WU T, et al.The study of the coexistence of hashimoto's thyroiditis with papillary thyroid carcinoma[J].Cancer Res Clinical Oncology, 2014, 140 (6) :1021-1026.
[16]	[16]LIU Y, YUN X, GAO M, et al.Analysis of regulatory T cells frequency in peripheral blood and tumor tissues in papillary thyroid carcinoma with and without Hashimoto's thyroiditis[J].Clin Transl Oncol, 2015, 17 (4) :274-280.
[17]	[17]CAI Y F, WANG QX, NI C, et al.The clinical relevance of psammoma body and hashimoto thyroiditis in papillary thyroid carcinoma:a large case-control study[J].Medicine, 2015, 94 (44) :e1881.

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