7886例甲状腺结节手术患者临床与病理特点变迁

发布时间：2018-06-05 23:15

本文选题：甲状腺结节 + 临床特点　；参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：目的总结1994～2013年解放军总医院甲状腺结节手术患者资料,探讨20年间甲状腺结节手术患者临床与病理特点及其变化趋势。方法收集1994年1月至2013年12月于解放军总医院进行手术治疗并有明确病理结果的7886例甲状腺结节患者临床与病理资料,包括:年龄、性别、甲状腺结节检出方式、实验室及超声检查、术前是否进行超声引导下甲状腺结节穿刺活检术、手术方式、术后病理等,进行回顾性分析。结果1、20年间,甲状腺结节手术患者7886例,男性2305例,女性5581例,男女之比为1: 2.42。甲状腺癌患者男女之比为1: 2.54,不同性别甲状腺癌患者均呈逐年增加趋势,尤以女性增幅明显(P0.05),2013年甲状腺癌患者男女之比为 1: 3.07。2、患者平均年龄为47.03±12.21岁,主要分布在30～59岁(73.80%),男性平均年龄大于女性(48.46±12.74岁比46.44±11.93岁,P0.01)。其中,甲状腺癌患者平均年龄44.30±11.72岁,高发年龄为30～59岁。3、体检是甲状腺结节的主要检出方式(占62.98%),仅8.36%患者由于心慌、声音嘶哑、吞咽或呼吸困难、饮水呛咳、颈部疼痛或不适等临床症状就诊。4、59.92%患者术前进行血清TSH检测。TSH水平在正常值低限(0.35-1.37 mU/L)时发生甲状腺恶性结节的比例最低(37.56%),随着TSH水平升高,恶性结节检出率逐渐上升,在正常值中位(2.41～3.43mU/L)时达高峰(57.02%),之后呈下降趋势,TSH水平5.50mU/L时,甲状腺恶性结节检出率为52.82%。5、实性、低回声、微钙化、边缘模糊、形态不规整等超声征像在恶性结节组更常见;微钙化和形态不规整的阳性预测值高于实性、低回声和边缘模糊,分别为 74.51%、75.62%、49.95%、50.38%、67.96%;微钙化的诊断准确率(70.56%)较其他超声征象高。6、26.77%(2111/7886)患者术前进行甲状腺结节穿刺活检术,自2004年起,术前接受超声引导下结节穿刺活检比例逐年增加,至2012年达高峰(70.18%)。7、4487例良性结节患者中,82.41% (3698/4487)接受甲状腺肿物切除术,11.95% (536/4487)进行甲状腺次全切除术,5.64% (253/4487)进行单侧甲状腺切除术。3399例甲状腺癌患者中,56.20% (1910/3399)进行甲状腺次全切除术,20.74% (705/3399)进行甲状腺全切/近全切除术,全切/近全切除术比例呈增长趋势(P0.01)。8、术后病理显示,良性结节以结节性甲状腺肿多见(42.40%, 3344/7886),恶性结节以乳头状癌比例最高(41.01%, 3234/7886)。甲状腺结节手术患者病例数逐年增长,但不同年份良恶性结节的构成比差异有统计学意义(P0.01),良性结节构成比由1994年的84.62%下降至2013年的32.20%,恶性结节检出率逐年上升,其中主要以甲状腺乳头状癌增加为主,占95.10% (3234/3399),而滤泡癌及其他罕见类型甲状腺癌逐年下降,仅4.90%(165/3399)。良性结节组患者的肿瘤平均直径大于恶性结节组(3.09±1.66cm比1.36±1.16cm),其中良性结节以直径2.0cm组多见(68.33%);结节直径≤2.0cm尤以≤1.0cm的甲状腺癌患者比例逐年增加(P0.01)。83.96% (2854/3399)患者为 TNM Ⅰ ～Ⅱ 期,自 2006年始,TNM Ⅲ～Ⅳ期患者所占比例呈下降趋势(P0.01)。结论1、解放军总医院20年间甲状腺结节手术患者病例数逐年增长,甲状腺恶性结节的构成比显著增加,良性结节构成比逐年下降。2、收治的患者多以查体发现结节就诊,大部分无临床症状。3、随着血清TSH水平升高,恶性结节检出率逐渐增加。4、甲状腺超声是评估甲状腺结节的常规检查,实性、低回声、微钙化、边缘模糊、形态不规整等超声征像对甲状腺恶性结节诊断有一定意义,综合分析多项超声征象有助于提高结节良恶性诊断准确率。5、进行术前超声引导下结节穿刺活检术的患者增加。6、甲状腺良性结节的主要术式为甲状腺肿物切除术;恶性结节的主要术式为次全切除术,近年来进行全切/近全切除术的患者增加。7、甲状腺癌尤其微小乳头状癌检出率呈逐年上升趋势,以女性增幅为著。8、晚期甲状腺癌患者比例减少,TNM Ⅲ～Ⅳ期患者所占比例呈下降趋势。
[Abstract]:Objective to summarize the data of the patients with thyroid nodule surgery in the General Hospital of PLA for 1994~2013 years and to discuss the clinical and pathological features of the patients with thyroid nodule surgery in the past 20 years and the trend of its change. Methods 7886 cases of thyroid nodules were collected from January 1994 to December 2013 in the General Hospital of PLA and had definite pathological results. The pathological data including age, sex, thyroid nodule detection, laboratory and ultrasound examination, ultrasound guided thyroid nodule biopsy, surgical methods, and postoperative pathology were reviewed. Results during 1,20, 7886 cases of thyroid nodule surgery, 2305 men, 5581 women, and the ratio of men and women. The ratio of male and female to 1: 2.42. thyroid cancer was 1: 2.54, and the incidence of thyroid cancer in different sexes increased year by year, especially in women (P0.05). In 2013, the ratio of male and female to thyroid cancer was 1: 3.07.2, the average age of the patients was 47.03 + 12.21 years old, mainly in 30~59 years (73.80%), and the average age of male was greater than that of women (48.46 +. 12.74 years old was 46.44 + 11.93 years old, P0.01). Among them, the average age of thyroid cancer patients was 44.30 + 11.72 years, and the age of high incidence was 30~59 years old. The physical examination was the main detection method of thyroid nodules (62.98%). Only 8.36% patients were diagnosed with.4,59.92% because of panic, hoarseness, dysphagia or dyspnea, choking of drinking water, neck pain or discomfort. The incidence of thyroid malignant nodules at the normal value low limit (0.35-1.37 mU/L) was the lowest (37.56%). As the level of TSH increased, the detection rate of malignant nodules increased gradually and reached the peak (57.02%) at the median of normal value (2.41 to 3.43mU/L), followed by a downward trend, and when TSH level 5.50mU/L, the thyroid was evil. The detection rate of sexual nodules was 52.82%.5, real, hypoechoic, microcalcification, blurred edge, and irregular shape, which were more common in the malignant nodule group, and the positive predictive value of microcalcification and morphologic inregularity was higher than that of the solid, and the hypoechoic and marginal ambiguity were 74.51%, 75.62%, 49.95%, 50.38%, 67.96%, respectively; the diagnostic accuracy of microcalcification was 70.56% compared with that of it. He performed thyroid nodule biopsy before operation in high.6,26.77% (2111/7886) patients. Since 2004, the proportion of ultrasound guided nodular puncture biopsy has increased year by year, and to the peak (70.18%) of the benign nodules in 2012 (70.18%), 82.41% (3698/ 4487) received thyroidectomy and 11.95% (536/4487). Subtotal thyroidectomy, 5.64% (253/4487) for unilateral thyroidectomy in.3399 cases of thyroid cancer, 56.20% (1910/3399) for subtotal thyroidectomy, 20.74% (705/3399) for total thyroidectomy / near total resection, total resection / total resection rate increased (P0.01).8, postoperative pathology showed nodular nodules. The number of malignant nodules was the highest (41.01%, 3234/7886). The number of patients with thyroid nodules increased year by year, but the proportion of benign and malignant nodules in different years was statistically significant (P0.01), and the ratio of benign nodules decreased from 84.62% in 1994 to 32.20% in 2013 and malignant nodules. The detection rate was increasing year by year, mainly with papillary thyroid carcinoma increasing mainly, accounting for 95.10% (3234/3399), while follicular carcinoma and other rare types of thyroid cancer decreased year by year, only 4.90% (165/3399). The average diameter of the tumor in the benign nodule group was greater than that of the malignant nodule group (3.09 + 1.66cm ratio 1.36 + 1.16cm), and the benign nodules were in the 2.0cm diameter group. The proportion of thyroid cancer patients with nodular diameter less than 2.0cm and less than 1.0cm was increased year by year (P0.01) and.83.96% (2854/3399) patients were TNM I to II. Since 2006, the proportion of patients with TNM III to IV was decreasing (P0.01). Conclusion 1, the number of cases of thyroid nodules operated by PLA General Hospital increased year by year in 20 years. The constitution ratio of thyroid malignant nodules increased significantly, the proportion of benign nodules decreased by.2 year by year, and most of the patients were found to be diagnosed with nodules, most of which had no clinical symptoms of.3. With the increase of serum TSH level, the detection rate of malignant nodules gradually increased.4. Thyroid ultrasound was the routine examination of thyroid nodules, real, hypoechoic, microcalcium. It is useful for the diagnosis of thyroid malignant nodules. The comprehensive analysis of multiple ultrasonic signs helps to improve the accuracy of the diagnosis of nodular benign and malignant.5. The patients with preoperative ultrasound guided nodular biopsy can increase.6. The main operation of thyroid gland benign nodules is thyroid tumor excision. The main operation of malignant nodules was subtotal resection. In recent years, the patients with total resection / total resection increased.7. The detection rate of thyroid carcinoma, especially small papillary carcinoma, was increasing year by year. The increase of female was.8, the proportion of advanced thyroid cancer decreased, and the proportion of patients in TNM III to IV was declining.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R653

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