甲状腺肿瘤普外科手术治疗临床特点分析

普外科手术治疗作为一种的治疗甲状腺肿瘤的治疗方法,已被越来越多的应用在医学上帮助甲状腺肿瘤患者解决病症.分析这种治疗方法的临床特点我们更为关注的是它的安全性和科学性,为以后的治疗提供了更加有效的判断依据,有非常重要的借鉴意义.本文对甲状腺肿瘤普外科手术治疗临床特点进行了分析总结并给出了相关建议,希望能对整个甲状腺肿瘤普外科手术的治疗起到良好的帮助作用.     

甲状腺微小癌16例诊治分析

[目的]研究甲状腺微小癌的临床特点、诊断及治疗方法.[方法]回顾性分析1992-10～2006-04手术治疗的甲状腺癌103例的临床资料,其中甲状腺微小癌16例,占同期甲状腺癌病人的15.53%,全部患者均经手术治疗并对其进行随访,随访2个月～10 a.[结果]①甲状腺微小癌与显性甲状腺癌在淋巴结转移上没有明显差异,甲状腺微小癌具有更多的多灶性生长特点,显性甲状腺癌有更多的外侵包膜现象.②B超在诊断甲状腺微小癌上有明显优势.[结论]甲状腺微小癌与显性甲状腺癌在生物学行为及淋巴结转移上没有明显差异,其治疗应遵循甲状腺癌的治疗原则.     

47例甲状腺微小癌诊治分析

目的：探讨甲状腺微小癌的临床诊断和治疗方法。方法：对诊断明确的47例甲状腺微小癌进行回顾性分析。结果：术前仅12例疑为甲状腺癌．余35例均于术中冰冻和术后病理确诊。34例合并甲状腺良性疾病，伴颈淋巴结转移3例。47例中有11例术后无瘤生存时间≥10年，24例术后无瘤生存时间≥5年。结论：甲状腺微小癌术前不易确诊，且易漏诊，对甲状腺良性疾病手术时应仔细触诊，对可疑结节行冰冻切片。首次手术应行患侧腺叶及峡部切除术．有淋巴结转移者行功能性淋巴结清扫术可取得较好疗效。     

甲状腺手术的护理体会

甲状腺疾病是头颈外科的常见病,目前治疗以手术切除为主,其疗效可靠,迅速,复发率低,但是术后容易发生各种并发症:出血、窒息、甲状腺危象等,严重者可导致死亡,我院自1996年以来,施行甲状腺手术近千例,由于加强了手术前后的病情观察和护理,积极有效的预防了手术并发症的发生。现将护理体会报告如下:1 术前护理任何患者在术前都会有一定的思想顾虑,对于自己的手术提出种种的疑问,此时,护理人员要做好耐心细致的解释工作,     

危重心脏病人甲状腺激素的变化

近年来由于内分泌激素测定的普遍应用,不但对甲状腺疾病的诊断、治疗及疗效观察起积极的作用,而且在一些危重的非甲状腺疾病中甲状腺激素发生明显的变化。并且对疾病的严重程度与患者血清中三碘甲状腺原氨酸(T_3)、甲状腺素(T_4)水平有明显相     

巨大甲状腺肿28例外科治疗分析

目的：探讨巨大甲状腺肿的外科治疗。方法：回顾分析2005年6月至2008年11月28例巨大甲状腺肿的治疗,其中11例行一侧甲状腺腺叶切除加对侧次切术;9例行单侧甲状腺腺叶加峡部腺叶切除术;双叶甲状腺次全切除术6例;2例行全甲状腺切除术,术后长期口服甲状腺片;其中2例并行同侧颈淋巴结清除术。结果：本组28例巨大甲状腺肿的手术切除,无手术死亡病例。所有病例均见甲状腺表面血管增粗、迂曲、扩张,有的甚至形成网状静脉窦。有囊性变或囊内出血19例;有钙化灶的7例;有癌灶的2例。术后病理诊断：单纯性甲状腺肿3例,结节性甲状腺肿20例,结节性甲状腺肿伴甲亢3例,甲状腺癌2例。结论：在巨大甲状腺手术时,术前检查的准确评估,术中操作技术的精细化和不断改进,甲状旁腺自体移植技术的开展,巨大甲状腺肿的手术治疗会更安全、合理。     

手术治疗与碘 -131 甲状腺功能亢进症的近远期疗效对 比简

目的：对比观察手术与碘-131治疗对甲状腺功能亢进症的近远期治疗效果并讨论得到较优的治疗方案：方法选取本科室收治的同期的400例甲状腺功能亢进症患者为研究对象,将其随机分为手术治疗组（手术组,n=200）与碘-131治疗组（碘-131,n=200）,比较两种治疗方法的近远期综合疗效;结果：从直接治疗效果看,手术组的治疗总有效率为90．50％．而碘-131组治疗总有效率为96．50％;从远期治疗效果看,手术并发症总发生率为3．50％,复发率为1,33％;碘-131总不良反应发生率为5．5％,复发率为0;结论：对于用手术及碘-131治疗甲状腺功能亢进症各有其优点及缺点,应视病人的不同情况和治疗目的予以选择,并且需要在治疗过程中采取一定的措施,如加强术前、术中、术后的护理。严格控制碘-131的用量以及配合抗甲状腺药物的治疗等,扬长避短．已达到最佳近远期疗效．     

怀孕前,请先检查甲状腺

在文章开始之前,先让我们看看下面的数字：甲状腺疾病是内分泌领域的第二大疾病,其中女性患者为男性患者的6～10倍,40岁以上的女性中有10％～20％的人群患有甲状腺疾病,但其治疗率在中国还不到2％。我们对甲状腺的关注确实太少了！     

核技术在亚急性甲状腺炎中的诊断价值

甲状腺疾病既属于内、外科疾病,也是流行病学常见病。评价甲状腺摄取无机碘离子的数量、速度,结合放射免疫检测循环血液中甲状腺激素的水平。在临床3412例疑似甲亢的病例中,经核医学检测手段筛选出47例亚急性甲状腺炎。为临床诊断提供了有力的佐证。亚急性甲状腺炎是甲状腺疾病中较少见的一种良性疾病,因常有类似甲亢症状,易被误诊,延误治疗本文仅就临床疑似甲亢的病例经核技术诊断为     

超声在甲状腺结节诊断中的临床意义

目的探讨超声在甲状腺结节诊断中的临床意义。方法通过超声检查甲状腺病变患者,观察结节的大小、结节内部及周边回声、结节的血供。结果超声检出甲状腺疾病114例,经病理证实的有106例。其中诊断出甲状腺结节43例,甲状腺炎19例,桥本氏甲状腺炎14例,甲状腺腺瘤13例,甲状腺机能亢进8例,甲状腺癌2例。结论超声检查方便,无损伤无痛苦,可重复对比观察,是检查甲状腺疾病的首选,值得推广应用。     

Preoperative localization and minimally invasive management of primary hyperparathyroidism concomitant with thyroid disease

The coexistence of thyroid diseases with primary hyperparathyroidism （PHPT） can present a challenge in the clinical diagnosis and management for these patients. This study aims to determine the frequency of coexisting thyroid gland lesions in a consecutive series patients with PHPT, and to analyze the clinical features, diagnosis and treatment of these patients. Twenty-two cases of a total of 52 PHPT patients who had synchronous thyroid and parathyroid pathology were surgically managed in this study Thirteen patients had ipsilateral thyroid nodules, and 9 patients had thyroid nodules in contralateral or bilateral side. Seven patients underwent direct parathyroidectomy and hemithyroidectomy via a mini-incision （about 3 cm）, while other 15 procedures were converted to Kocher incision. Seventeen nodular goiter （32.7%）, 2 thyroiditis （3.8%）, 2 thyroid adenoma （3.8%） and 1 thyroid carcinoma （1.9%） coexisting with parathyroid adenoma were pathologically diagnosed. The sensitivity of preoperative ultra- sonography （US） and methoxy-isobutyl-isonitrile （MIBI） scintigraphy for parathyroid lesions was 63.6% and 85.7%; and the overall positive predictive values for MIBI and US were 100% and 95.5% respectively. A high incidence of thyroid diseases that coexisted with PHPT in literatures was briefly reviewed. Our study illustrated the need for clinical awareness of concomitant PHPT and thyroid disease. A combination of US, computed tomography （CT） and MIBI scintigraphy would be recommended for preoperative localization of enlarged parathyroid adenoma and for evaluation of thyroid lesions. Synchronous treatment of associated thyroid abnormalities is desirable, and open minimally invasive surgical approach with additional resection of isolated ipsilateral thyroid nodules is possible in some of these patients.     

老年人大肠癌的外科治疗

目的：探讨老年人大肠癌的外科治疗方法。方法：回顾分析116例老年大肠癌的临床资料。结果：误诊率35％，共存病62％，肿瘤切除率75．9％，术后并发症发生率28％，围手术期死亡率5．7％。结论：手术切除是老年大肠癌病人的最好治疗方法，围手术期的正确处理是提高疗效的关键。     

临床路径在冠心病诊疗中的应用现状

临床路径工作模式已被运用于冠状动脉造影、急性心肌梗死、介入治疗、冠状动脉搭桥术、冠心病健康宣教等临床工作,并取得一定成效,通过对现状进行分析与讨论,指出在冠心病诊疗中使用临床路径工作模式有利于提高工作效率与服务质量。     

LEEP术治疗宫颈病变120例临床观察

目的：探讨LEEP术在治疗宫颈疾病中的作用。方法：对120例宫颈疾病患者采用LEEP术不同的方式治疗。结果：120例患者治疗效果明显。结论：LEEP操作简单,手术时间短,方法灵活,是目前治疗宫颈疾病的理想方法。     

二尖瓣病变合并冠心病13例外科治疗体会

目的总结二尖瓣病变合并冠心病的外科治疗体会。方法对13例二尖瓣病变合并冠心病患者同期行二尖瓣置换或成型及冠脉搭桥术,回顾性分析,临床资料。结果术后1例死于严重心律失常,其余均存活。随访3—36个月,心功能恢复至Ⅰ-Ⅱ级9例,Ⅲ级3例,未出现心肌缺血症状。结论术前明确诊断,充分准备,术中加强心肌保护,提高手术水平,缩短手术时间,加强围手术期治疗是手术成功的关键。     

诗中之意与诗外之"疫"--由唐诗的疫病表现说起

通过分析唐诗中的传染病记载，发现唐代是疫病的多发时期。其时的疫病主要通过水源扩散，重要的传染病为疟疾和瘴病，广泛流行于南方的大多数地区。从唐诗中，还可以看到疫鬼观念及其他迷信思想对唐代社会习俗、疫病救治、宗教发展的深刻影响，以及唐诗、疫病与社会人文背景的关系。     

Metastasis of gastric carcinoma to the thyroid and lung: a case report and review of literature

Cancer metastasis to the thyroid is extremely rare. The more commonly reported primary sites for metastasis to the thyroid are the kidney, breast, lung, colon, esophagus, and uterus. Thyroid metastasis from the stomach has only been reported in three cases. Herein, we report a 71-year-old man presenting with bilateral thyroid multinodular lesions. Bilateral near-total thyroidectomy was performed due to airway compression with related symptoms. Wedge resection of a suspicious pulmonary nodule, detected on CT, was performed for diagnosis. Polypoid lesions in the stomach were examined by trans-scopic biopsy. Poorly differentiated adenocarcinomas with the same histological profiles were noted at these three sites. The immunohistochemical staining for thyroglobulin of these specimens was negative. We conclude that a new thyroid mass appearing in a patient with present or prior malignancies should raise the concern of metastatic disease.     

PBL联合CBL教学模式在动物外产科疾病教学中的应用

动物外产科疾病是动物医学及其相关专业的一门重要的职业技术课程,传统的教学方式是先理论、后实践,以教师讲解为主,缺乏学生讨论和回答问题环节,学生对学习的目的和意义不明确,对所学内容印象不深,难以和临床实际联系起来。将案例教学法（CBL）和以问题为基础的教学法（PBL）联合应用于动物外产科疾病教学中,既可培养学生独立思考、分析和解决问题的临床思维能力,又可激发学生学习的积极性,从而提高动物外产科疾病课程的教学质量。     

低分子肝素钠治疗重症肺心病疗效观察

目的：评价低分子肝素钠对重症肺心病患者的疗效和副作用。方法：将92例重症肺心病患者随机分为两组，观察组45例，给予低流量持续吸氧、抗感染、祛痰、止咳平喘、改善心肺功能等常规治疗；治疗组47例在常规治疗基础上加用低分子肝素钠5000IU，皮下注射，每日2次．连用7d。结果：治疗组与观察组治疗后血液流变学及动脉血氧分压比较差异有显著性（P〈0．05）。结论：低分子肝素钠治疗重症肺心病有显著疗效。     

Five-year longitudinal evaluation of quality of life in a cohort of patients with differentiated thyroid carcinoma

Differentiated thyroid carcinoma (DTC) generally has a favorable outcome. Thyroid disease, treatments, stress, and comorbidity can compromise health-related quality of life (QoL) and indirectly weigh upon the outcome. From 2004 to 2008, we evaluated QoL longitudinally in 128 DTC subjects. During scheduled examinations, subjects were asked to undergo a semi-structured psychiatric interview and five rated inventories. The same examination was conducted in 219 subjects after surgery for benign thyroid pathology. Low scores represent a better QoL. DTC and control subjects were similar in terms of age, male/female ratio, concomitant psychopharmacological treatments, and frequency of psychiatric diseases. In DTC subjects, Billewicz scale (BS) scores showed an increasing trend over time, especially among females. The ad hoc thyroid questionnaire (TQ) scores were similar in both groups and did not change over time, but at the end of the study ad hoc TQ and BS were significantly related. Ad hoc TQ scores were also related to age on entry to the study. In both male and female DTC subjects, Hamilton’s tests for anxiety (HAM-A), but not for depression (HAM-D), showed an improving trend. At the end of the study, HAM-A and HAM-D scores were comparable to those of the control group. HAM-A and HAM-D were both positively correlated with the stage of cancer and the time between diagnosis and treatment. Only HAM-D correlated with age on entry to the study. Kellner symptom questionnaire (KSQ) item scores were higher in DTC subjects than in controls. The change over time in the items including anxiety, somatization, depression, and hostility was significant. Somatization and hostility were more significantly reduced in DTC females than in DTC males. Hostility scores were significantly lower in DTC subjects than in controls at the end of the study. Somatization and depression were significantly related to staging on diagnosis and age on entry to the study. Our study confirms a wide variation of illness perception in DTC subjects, which is generally unrelated to the favorable clinical follow-up of the disease. Psychological evaluation during long-term follow-up improved QoL scores, which reached the same levels noted in subjects with a history of thyroid surgery for benign thyroid pathology. Our data indicate that special attention should be paid to QoL in older DTC subjects and those with more severe staging on diagnosis.