目的:探讨郎罕氏组织细胞增多症累及甲状腺的临床表现,诊治及预后。方法: 淋巴结病理活检及免疫组化证实郎罕氏组织细胞增多症的诊断,颈部血管彩超发现甲状腺长大。予以小剂量化疗。结果: 2例患者均为系统性郎罕氏组织细胞增多症,累及甲状腺,予以小剂量化疗后,其中1例患者,化疗后淋巴结及甲状腺明显缩小。另1例患者广泛受累,化疗后效果差。结论: 郎罕氏组织细胞增多症累及甲状腺者罕见,可表现为甲状腺单独受累或伴多系统受累,对前者可采用甲状腺部分或全切术,疗效好;对于多器官受累者多采用联合化疗,但疗效较差。
Objective To evaluate the markers which contribute to diagnosis and prognosis of thyroid neoplasm. Methods The references about thyroid markers in recent years were reviewed. Results CD26 and galectin-3 could be regarded as a simple, potent markers to differentiate thyroid carcinoma in preoperative diagnosis, CD97 was a specific marker for undifferentiated thyroid carcinoma and its metastasis, CD15 and telomerase could be used in fine-needle aspirate biopsy (FNAB) of thyroid mass, and to improve its diagnostic evaluation, RET/PTC was mainly expressed in thyroid medullary carcinoma, oncofetal fibronectin (oncFN) was specific to papillary and anaplastic carcinoma, thyroid peroxidase was used to identify benign and malignant thyroid tumor. Conclusion Although there are a lot of markers for thyroid neoplasm, but there is no marker which are completely specific to certain histotype of thyroid neoplasm at present.
Objective The aim of this study is to review the molecular landscape of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Method The relevant literatures about molecular profiling of NIFTP were retrospectively analyzed and summarized. Results The most common mutation in NIFTP was rat sarcoma viral oncogene homolog (RAS) mutation. B-type RAF (BRAFK601E) mutation, PPARG fusion, and THADA fusion also could be seen. There was usually no BRAFV600E mutation. miRNAs also were found to be differentially expressed in NIFTP. Conclusion The molecular profiling of NIFTP may become a new molecular marker for the diagnosis of NIFTP.
目的 探讨经胸骨前径路内镜甲状腺手术的方法及其临床效果。 方法 采用经胸骨前径路内镜甲状腺手术治疗24例甲状腺良性肿瘤患者，并进行定期随访。 结果 23例手术顺利完成，1例因术中快速冰冻病理诊断为乳头状甲状腺癌而追加常规甲状腺癌根治术。平均手术时间为150 min，术中平均出血量30 ml。2例出现皮下气肿，4例出现胸部皮肤麻木。无喉返神经及甲状旁腺损伤,无术后出血、甲状腺危象等并发症出现。随访1~6个月，所有患者对美容效果非常满意，无近期肿瘤复发者。 结论 经胸骨前径路内镜甲状腺手术是一种美容效果较好的手术方法，手术操作空间的建立和术中控制出血是该术式的两大关键技术。
Thyroid disease is more common in young women. Traditional surgical scars may affect the appearance of patients and cannot fully meet the cosmetic needs of patients. With the advancement of surgical techniques, endoscopic thyroid surgery has developed rapidly. Trans oral endoscopic thyroidectomy vestibular approach is feasible and safe to achieve no scar on the body surface, but there are some unavoidable limitations, such as postoperative numbness and discomfort in the center of the chin region. As a new approach to thyroid surgery, trans oral endoscopic thyroidectomy submental access has the same advantages as the trans oral vestibular approach from top to bottom, and can reliably and thoroughly dissect lymph nodes in the central area (especially area Ⅶ), allowing larger specimens to be taken out and expands the indications for surgery, minimizes flap detachment, and avoids jaw pain and numbness. Trans oral endoscopic thyroidectomy submental access is an innovation in the concept of thyroid surgery, which achieves minimally invasive and aesthetic results on the premise of ensuring the quality of the surgery and curing the disease. We reviewed the history, advantages and disadvantages of trans oral endoscopic thyroidectomy submental access.
目的探讨再次手术治疗复发性结节性甲状腺肿的安全性及有效性。 方法回顾性分析2004年1月至2012年12月期间于笔者所在医院行再次手术治疗的48例复发性结节性甲状腺肿患者的临床资料。 结果本组48例患者中，再次手术行甲状腺全切除术33例，行甲状腺近全切除术15例。术中显露喉返神经32例（61条），均无喉返神经损伤发生；未能显露喉返神经16例，其中有2例发生喉返神经损伤，损伤率为12.5%，高于显露喉返神经者（P＜0.05）。术后均无永久性低钙血症发生，17例（35.4%）发生暂时性低钙血症。术后均获访0.5～8.0年，平均4.3年，无复发。 结论复发性结节性甲状腺肿再次手术行甲状腺全切除或近全切除术是安全可靠的，预防术后并发症的关键是熟悉甲状腺解剖和精细手术操作。
Objective To evaluate the impact of total thyroidectomy on health-related quality of life （HRQOL） in patients with nodular goiter. Methods The patients who underwent total thyroidectomy from Jan. 2009 to Dec. 2011 in our hospital were retrospectively analyzed with regard to the quality of life （total thyroidectomy group）. The patients with similar demographic features who underwent hemithyroidectomy during the same period were matched as control （hemi-thyroidectomy group）. The validated HRQOL instrument， which was the Euro quality of life-5D （EQ-5D）， was applied to measure the HRQOL. Comparison of HRQOL in patients of 2 groups was performed， meanwhile， the data of total thyroidectomy group was compared with data of normal population who were obtained from The Forth National Health Survey. Results There were 26 and 28 valid questionnaires returned for the total thyroidectomy group and hemithyroi-dectomy group respectively. The demographic features of patients in 2 groups were comparable. No significant variancecould be found between the 2 groups that there were no significant differences on the mobility， self-care， usual activities，pain/discomfort， anxiety/depression， and visual analogous scales （P＞0.05）. Furthermore， no significant differences in HRQOL were found in EQ-5D questionnaire compared with normal population derived from The Forth National Health Survey （P＞0.05）， except that there were more patients complained of moderate and severe pain/discomfort in the total thyroidectomy group 〔30.8% （8/26） vs.9.2% （16 330/177 501）， P＜0.01〕. Conclusion Total thyroidectomy appears to have little impact on the quality of life in the patients with nodular goiter.
ObjectiveTo summarize and analyze the clinical characteristics of patients with thyroiditis who would be misdiagnosed with thyroid tumor easily. MethodThe clinical data of 19 patients with thyroiditis who were misdiag-nosed with thyroid tumor in our department from 2009 to 2012 were analyzed retrospectively. ResultsAll of 19 patients underwent surgery, among which 8 cases were diagnosed with chronic lymphocytic thyroiditis after operation, 10 cases diagnosed with subacute thyroiditis, and 1 case diagnosed with suppurative thyroiditis.Different surgery program such as the biopsy or wedge resection was adopted to the subacute thyroiditis and the chronic lymphocytic thyroiditis respec-tively. ConclusionSometimes, it is very difficult to distinguish atypical thyroiditis from thyroid tumor so that we must pay attention to the patients who had nontumorous characteristics in order to decrease the misdiagnosis.
目的 探讨复发性结节性甲状腺肿再手术中喉返神经损伤的预防方法。方法 回顾性分析笔者所在单位1996年7月至2009年7月期间再次手术治疗的56例复发性结节性甲状腺肿患者的临床资料，术中行喉返神经解剖31例，未行喉返神经解剖25例。 结果 未行喉返神经解剖者中有3例出现暂时性喉返神经损伤，损伤率为12.0%；行喉返神经解剖者中无一例出现喉返神经损伤，损伤率为0；两者之间差异有统计学意义（χ2=3.931，P＜0.05）。 结论 复发性结节性甲状腺肿再手术时解剖喉返神经有助于降低喉返神经的损伤；术中精细的操作和细致的解剖是避免喉返神经损伤的关键。