摘要
目的总结甲状腺结核(thyroid tuberculosis,TTB)的诊治经验,以提高临床对该疾病的诊治水平。方法亲新疆伊犁哈萨克自治州友谊医院普外二科2020年4月收治1例巨大甲状腺占位患者,无结核病史,通过B超及增强CT诊断考虑甲状腺癌而行手术治疗,术后病理诊断为TTB。检索国内数据库中的相关文献,回顾分析国内文献报道的357例TTB的临床、病理资料。结果本文报道1例经术后病理诊断TTB,经手术及全身抗结核治疗后痊愈。在回顾357例TTB病例中,男95例,女262例,男女比为1.0:2.8;多数以颈部肿物为首发症状(95.5%,256/268),合并结核中毒症状者53例(19.8%,53/268);59例(20.9%,59/281)合并甲状腺外结核;术前穿刺51例,明确诊断TTB37例(72.5%,37/51);术前怀疑甲状腺癌80例(30.2%,80/265);25例单纯抗结核治疗(8.5%,25/294),269例行手术治疗(91.5%,269/294),其中单侧叶切除100例(37.1%,100/269);术后病理类型中以干酪型多见,154例(57.9%,154/266);2例TTB术后死亡,余例随访6个月~33年无复发。结论TTB多缺乏典型结核病的临床表现,易与甲状腺癌混淆,诊断主要依据穿刺病理学检查;在明确诊断的基础上选择恰当的治疗方式可取得较好的疗效。
Objective To sum up the experience and improve the capability of clinical diagnosis and treatment of thyroid tuberculosis(TTB).Methods In Apr.2020,the Second Department of General Surgery,Friendship Hospital of Yili Kazakh Autonomous Prefecture,Xinjiang,treated a patient with a huge thyroid cancer(TC),who had no history of tuberculosis.Thyroid cancer was considered for surgical treatment after the assessment by ultrasound and enhanced CT scan,yet the postoperative pathological diagnosis was thyroid tuberculosis.The clinical and pathological data of 357 cases of TTB reported in domestic literature were retrospectively analyzed by searching the relevant databases.Results This reported case was diagnosed eventually with TTB by postoperative pathology,cured by operation,local and systemic anti-tuberculosis treatment.Among the 357 cases of TTB,there were 95 males and 262 females and the ratio of male to female was 1.0:2.8.Most patients had neck mass as the first symptom(95.5%,256/268),and 53 patients(19.8%,53/268)merged with tuberculosis poisoning symptoms.There were 59 cases(21%,59/281)complicated with extra-thyroid tuberculosis.Among 51 cases,37 cases(73%,37/51)were diagnosed with TTB.Eighty cases(30%,80/265)were suspected of TC before the operation.25 pa-tients(8.5%,25/294)received antituberculosis treatment,and 269 patients(91.5%,269/294)received surgical treatment,among which 100 patients(37%,100/269)underwent unilateral lobectomy.The caseation type was the most common pathology with 154 cases(57.9%,154/266).Two patients died of TTB after an operation,and the re-maining patients were followed up for 6 months to 33 years without recurrence.Conclusions TTB often lacks typical clinical manifestations and is easily confused with TC.The diagnosis mainly relies on puncture pathological examination.Good results can be achieved with appropriate treatment based on a definite diagnosis.
作者
帕拉沙特·叶尔肯别克
沙力木·库努斯王霆
王霆
何力鹏
王瑞哲
刘萧
廖泉
李小毅
钟定荣
胡长军
Palashate·Yeerkenbieke;Shalimu·Kunusi;Wang Ting;He Lipeng;Wang Ruizhe;Liu Xiao;Liao Quan;Li Xiaoyi;Zhong Dingrong;Hu Changjun(Department of Second General Surgery,Ili Kazakh Autonomous Prefecture Friendship Hospital,Ili 835000,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pathology,China Japan Friendship Hospital,Beijing 100730,China)
出处
《中华内分泌外科杂志》
CAS
2023年第4期455-458,共4页
Chinese Journal of Endocrine Surgery
关键词
甲状腺
结核
Thyroid gland
Tuberculosis(TB)
