Diaconescu M R, Strat V, Chifan M, Georgescu S, Bordea M, Zbranca E, Mogoş V, Găleşanu C, Dobrescu G, Baran T
Clinica de chirurgie IV, Institutul de Medicină şi Farmacie, Iaşi.
Rev Chir Oncol Radiol O R L Oftalmol Stomatol Chir. 1990 Jan-Feb;39(1):1-10.
The main problem posed by an (apparent) solitary thyroid nodule is cancer identification, present in about 10% of the nodules excised surgically. This percent might increase to 25-30% in the cold scintigraphic nodules. Therefore, a combination of all the methods for nodule assessment is necessary: anamnesis, physical examination, functional tests, therapeutic test with tyrosine and thyroid imaging, but mainly the intensive active exploration including puncture-biopsy with a fine needle and exeresis with extemporaneous and paraffin morphological checking. Starting from a two decades' experience of a group of endocrinologists, surgeons, anatomo-pathologists and specialists in nuclear medicine, in 2,289 thyropathies operated--of whom 1691 (poly)nodular goitres and 1,190 non-capturing nodules--the authors suggest an investigation algorithm for achieving a differentiated surgery in terms of the pre- and intraoperative morphological findings. This attitude permitted both the improvement of the surgeries of thyroid cancers and the exeresis of benign nodules under low-risk surgical conditions or avoidance of a "non-necessary" surgery.
（明显的）孤立性甲状腺结节带来的主要问题是鉴别癌症，在手术切除的结节中约10%存在癌症。在冷闪烁扫描结节中，这一比例可能会升至25% - 30%。因此，有必要综合运用所有评估结节的方法：问诊、体格检查、功能测试、酪氨酸治疗测试及甲状腺成像，但主要是进行深入的主动探查，包括细针穿刺活检以及切除并进行即时和石蜡形态学检查。基于一组内分泌学家、外科医生、解剖病理学家和核医学专家二十年的经验，在2289例接受手术的甲状腺疾病患者中（其中1691例为（多）结节性甲状腺肿，1190例为无摄取结节），作者提出了一种根据术前和术中形态学发现进行差异化手术的调查算法。这种做法既提高了甲状腺癌手术的效果，又能在低风险手术条件下切除良性结节，或避免进行“不必要”的手术。
