贵州医科大学学报

2015, v.40;No.183(12) 1391-1394

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40岁以上甲状腺结节患者手术后临床和病理特点
Clinical and Pathological Characteristics of Thyroid Nodules of Patients Over 40 after Operation

何德奇;时立新;唐鲲;任婷;
HE Deqi;SHI Lixin;TANG Kun;REN Ting;Guizhou Medical University;Department of Endocrine and Metabolic Diseases,Affiliated Hospital of Guizhou Medical University;Medical Record Room,Affiliated Hospital of Guizhou Medical University;

摘要(Abstract):

目的:分析40岁以上中老年人甲状腺结节(TN)的临床和病理特点。方法:收集行TN手术治疗且年龄≥40岁患者533例病历资料,分析TN的一般情况,性别、年龄及术后TN的病理类型和良恶性的构成,分析术前促甲状腺激素(TSH)水平与TN良恶性关系;以术后病理结果为标准分析评价患者术前超声、细针穿刺诊断的准确性,以结节良恶性为因变量采用多因素logistic回归分析方法预测甲状腺恶性结节的危险因素。结果:在40~59岁中老年人TN多见,男女TN恶性率分别为23.4%、13.6%;TN病理类型中良性结节以单纯性结节性甲状腺肿和甲状腺腺瘤最多见(56.6%,11.1%),恶性结节中以甲状腺乳头状癌为主(13.9%),其余髓样癌及其他占1.2%;单发、实性、大结节恶性率高于多发、混合性结节,囊性结节恶变性较低;术前超声、细针穿刺诊断与术后病理诊断对比符合率分别为82.8%、94.9%,恶性结节比例随着术前TSH水平增高而增加,回归分析结果显示性别、术前TSH是预测TN恶性结节的危险因素。结论:40岁以上中老年TN恶性率男性高于女性;超声、细针穿刺及TSH检查对TN良恶性鉴别有重要诊断价值。
Objective: To analyze the clinical and pathological characteristics of thyroid nodules of people over 40. Methods: The clinical data of 533 patients above 40 years old with surgical treatment of thyroid nodules( TN) were collected and given a retrospective analysis about TN,sex,age,pathological type and propotion of benign and malignant cases after operation. The accuracy of preoperative ultrasound diagnosis,fine-needle aspiration diagnosis was assesssed according to postoperative pathological result. The benign or malignant nodules was taken as dependent variable and the risk factors of thyroid malignant nodules were analyzed and predicted by multivariate logistic regression analysis method.Results: Thyroid nodule was common in middle-aged and elderly people aged from 40-year old to 59-year old. The malignant rate of TN was 23. 4% and 13. 6%,respectively. In the benign nodules of TN pathological type,the simple nodositas goiter and thyroid adenoma were most common( 56. 6% and11. 1%,respectively),and thyroid papillary carcinoma was most common( 13. 9%) in malignant nodules. The medullary carcinoma and other accounted for 1. 2%. The maglignant rate of single,solid,large nodule was higher than that of multiple,mixed nodules and the malignant rate of cystic nodules was lower. The comparison coincidence rate between preoperative ultrasound diagnosis,fine-nee-dle aspiration diagnosis and postoperative pathological diagnosis result were 82. 8% and 94. 9%,respectively. The proportion of malignant nodules increased with the increase of TSH levels. The regression analysis results showed that preoperative TSH was a risk factor for predicting TN malignant nodules. Conclusion: The rate of malignant thyroid nodule in male is higher than in female among the middle-aged and elderly people over 40 years old. Ultrasound,fine needle aspiration and TSH examination are of important diagnostic value in distinguishing benign from malignant TN.

关键词(KeyWords): 甲状腺结节;中年人;老年人;超声检查,多普勒,彩色;穿刺术
thyroid nodule;middle-aged people;elderly people;ultrasonic inspection,Doppler,colour;puncture

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作者(Author): 何德奇;时立新;唐鲲;任婷;
HE Deqi;SHI Lixin;TANG Kun;REN Ting;Guizhou Medical University;Department of Endocrine and Metabolic Diseases,Affiliated Hospital of Guizhou Medical University;Medical Record Room,Affiliated Hospital of Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2015.12.028

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