Kuma K, Matsuzuka F, Kobayashi A, Hirai K, Morita S, Miyauchi A, Katayama S, Sugawara M
Kuma Hospital, Second Department of Surgery, Kagawa Medical School, Kobe, Japan.
World J Surg. 1992 Jul-Aug;16(4):583-7; discussion 587-8. doi: 10.1007/BF02067327.
We investigated the outcome of long standing palpable solitary thyroid nodules by surveying 441 patients and examining 140 patients who had untreated thyroid nodules for 15 +/- 4.5 years. In our clinical survey, the most common outcome was disappearance of the thyroid nodule (38.3%). Also a significant number of patients (36.3%) underwent surgery in other hospitals. Five (1.1%) patients died of thyroid cancer. When thyroid nodules were re-examined, most nodules indeed decreased in size or disappeared; however, 13% of nodules increased in size. Ultrasound of the nodules showed that most solitary nodules were multiple and partially cystic and solid. There was an increased incidence of calcification in long standing nodules. Thyroid cancer was found by fine needle aspiration biopsy in 26.3% of enlarging nodules and 6.4% of nodules without changing size. The risk of cancer decreased when the size of the nodule decreased. A total of 15 patients with suspicion of malignancy underwent surgery. Surgical procedures were lobectomy, near total thyroidectomy, or resection of nodules with or without modified neck dissection. Seven patients had papillary carcinoma and 2 patients with benign cytology had microscopically evident papillary carcinoma. In our study, the majority of palpable solitary thyroid nodules tended to decrease in size; these nodules do not require treatment. Enlarging solid nodules are a definite risk for thyroid cancer. If the size of the nodule remains the same, judicious approach with fine needle aspiration biopsy is needed.
我们通过对441例患者进行调查，并对140例未经治疗的甲状腺结节患者进行了15±4.5年的检查，研究了长期可触及的孤立性甲状腺结节的转归。在我们的临床调查中，最常见的转归是甲状腺结节消失（38.3%）。也有相当数量的患者（36.3%）在其他医院接受了手术。5例（1.1%）患者死于甲状腺癌。当对甲状腺结节进行复查时，大多数结节确实缩小或消失了；然而，13%的结节增大了。结节的超声检查显示，大多数孤立结节是多发的，部分为囊性和实性。长期存在的结节钙化发生率增加。在26.3%的增大结节和6.4%大小未改变的结节中，通过细针穿刺活检发现了甲状腺癌。当结节尺寸缩小时，癌症风险降低。共有15例疑似恶性肿瘤的患者接受了手术。手术方式为叶切除术、近全甲状腺切除术或有或无改良颈清扫的结节切除术。7例患者患有乳头状癌，2例细胞学检查为良性的患者在显微镜下有明显的乳头状癌。在我们的研究中，大多数可触及的孤立性甲状腺结节倾向于缩小；这些结节无需治疗。增大的实性结节是甲状腺癌的明确风险因素。如果结节大小保持不变，则需要谨慎地进行细针穿刺活检。
