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原发性甲状腺结核的临床诊断与治疗:一项回顾性研究。

Clinical diagnosis and treatment of primary thyroid tuberculosis: a retrospective study.

机构信息

MD. Surgeon, Department of Thyroid Surgery, First Hospital of Jilin University, Jilin Province, China. 0000-0002-4052-6379.

MD, PhD. Anesthesiologist and Professor, Department of Anesthesia, First Hospital of Jilin University, Jilin Province, China. 0000-0001-6275-1035.

出版信息

Sao Paulo Med J. 2022 Jul-Aug;140(4):547-552. doi: 10.1590/1516-3180.2021.0380.R1.29102021.

Abstract

BACKGROUND

Primary thyroid tuberculosis (PTT) is an uncommon type of extrapulmonary tuberculosis, which is caused by Mycobacterium tuberculosis. It does not have specific clinical manifestations, and most cases are diagnosed through postoperative histopathological examination.

OBJECTIVE

To evaluate the diagnostic pattern and management strategy among patients with primary thyroid tuberculosis.

DESIGN AND SETTING

Retrospective study on patients with primary thyroid tuberculosis in the First Hospital of Jilin University (Changchun, China).

METHODS

Between March 2015 and June 2020, nine cases of PTT were diagnosed and treated in the Department of Thyroid Surgery of the First Hospital of Jilin University. Age at diagnosis, primary symptoms, preoperative biopsy, operation method, pathological classification, acid-fast staining test, anti-TB therapy and prognosis were registered in order to explore the appropriate protocol for diagnosis and treatment of this disease.

RESULTS

None of the patients was diagnosed with thyroid tuberculosis before surgery. All the patients underwent surgery. Granulomatous changes or caseous necrosis in thyroid tissue were found through postoperative histopathological evaluation. Polymerase chain reaction (PCR) results for Mycobacterium tuberculosis were positive in all patients. Most patients had a good prognosis after surgery and anti-tuberculosis drug therapy.

CONCLUSION

PTT is a rare disease. It is important to improve the preoperative diagnosis. Preoperative diagnostic accuracy relies on increased awareness of the disease and appropriate use of preoperative diagnostic methods, such as PCR detection, fine-needle aspiration cytology, acid-fast bacillus culture, ultrasound and blood sedimentation. PCR detection of M. tuberculosis is recommended as the gold standard for diagnosis.

摘要

背景

原发性甲状腺结核(PTT)是一种罕见的肺外结核,由结核分枝杆菌引起。它没有特定的临床表现,大多数病例通过术后组织病理学检查来诊断。

目的

评估原发性甲状腺结核患者的诊断模式和管理策略。

设计和设置

吉林大学第一医院(中国长春)的原发性甲状腺结核患者的回顾性研究。

方法

2015 年 3 月至 2020 年 6 月,吉林大学第一医院甲状腺外科共诊断和治疗了 9 例 PTT 患者。为了探讨该病的适宜诊断和治疗方案,我们对患者的年龄、首发症状、术前活检、手术方法、病理分类、抗酸染色试验、抗结核治疗和预后进行了登记。

结果

所有患者术前均未诊断为甲状腺结核,均行手术治疗。术后组织病理学评估发现甲状腺组织有肉芽肿性改变或干酪样坏死。所有患者的聚合酶链反应(PCR)结果均为结核分枝杆菌阳性。大多数患者在手术后和抗结核药物治疗后预后良好。

结论

PTT 是一种罕见疾病。提高术前诊断水平非常重要。术前诊断的准确性取决于对该病的认识提高和术前诊断方法的适当应用,如 PCR 检测、细针抽吸细胞学检查、抗酸杆菌培养、超声和血沉。PCR 检测结核分枝杆菌被推荐为诊断的金标准。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2fb5/9491481/e0d3d0a6f55a/1806-9460-1516-3180-2021-0380-R1-29102021-gf01.jpg

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