甲状腺结节的诊治19

ChangzhengHospital甲状腺结节的诊治上海长征医院内分泌科邹俊杰ChangzhengHospital甲状腺结节•甲状腺内的肿块，可随吞咽动作随甲状腺而上下移动，临床常见•结节的大小、位置、质地、功能及其临床意义各有不同ChangzhengHospital流行病学•2010年中华医学会内分泌学分会甲状腺结节患病率18.6%•高分辨率超声甲状腺结节的检出率为19%~67%于晓会,单忠艳.中国实用外科杂志,2010ChangzhengHospital流行病学ChangzhengHospital病因•感染•自身免疫•肿瘤•出血•甲状腺检测技术的进步？ChangzhengHospital结节分类•结节性甲状腺肿•结节性毒性甲状腺肿（Plummer病）•炎性结节感染性（急性、亚甲性；细菌、病毒、真菌、结核）非感染性（自身免疫性甲状腺炎）慢性硬化性甲状腺炎（Riedel病）ChangzhengHospital结节分类•甲状腺囊肿•甲状腺内出血•甲状腺肿瘤腺瘤甲状腺癌（乳头状癌、滤泡癌、髓样癌、未分化癌）ChangzhengHospital结节分类•甲状腺间质组织肿瘤海绵状血管瘤、颗粒细胞瘤、纤维瘤、肌瘤、肉瘤•甲状腺内其它组织来源的肿瘤转移癌、淋巴瘤胸腺、唾液腺、副神经节瘤畸胎瘤ChangzhengHospital甲状腺结节的检查ChangzhengHospital体格检查ChangzhengHospital体格检查ABCDEFChangzhengHospital体格检查ChangzhengHospital体格检查ChangzhengHospital体格检查ChangzhengHospital体格检查ChangzhengHospital体格检查ChangzhengHospital体格检查ChangzhengHospital体格检查ChangzhengHospital甲状腺结节的检查•血清学检查：T3、T4、FT3、FT4、TSHTg降钙素CEAChangzhengHospital核素扫描ChangzhengHospital核素扫描ChangzhengHospital核素扫描ChangzhengHospital超声检查•US甲状腺位置表浅解剖结构不同于周围组织最重要•彩色多普勒血流显像（CDFI）•2-3mmChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声VladimirP.Kharchenko.UltrasoundDiagnosticsofThyroidDiseases，2010ChangzhengHospital甲状腺结核ChangzhengHospital甲状腺结核ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospitalChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺超声ChangzhengHospital甲状腺滤泡癌ChangzhengHospital甲状腺滤泡癌ChangzhengHospitalJKoreanMedSci2013;28:156-159ChangzhengHospital甲状腺未分化癌ChangzhengHospital甲状腺内淋巴瘤ChangzhengHospital甲状腺内淋巴瘤ChangzhengHospitalCT检查•甲状腺肿大的程度（与气管的关系）•鉴别结节的良恶性•判断甲状腺癌有无周围结构侵犯、局部淋巴结转移、或远处转移局部复发ChangzhengHospitalCT检查ChangzhengHospitalCT检查ChangzhengHospitalCT检查ChangzhengHospitalCT检查ChangzhengHospitalCT检查ChangzhengHospitalCT检查ChangzhengHospitalCT检查ChangzhengHospitalMRI检查•Allthyroidpathologieswithasuspectedsubsternalcomponent•Biggoiter•DiscordantordisputableresultsfromUSorothervisualizationmodalitiesChangzhengHospitalMRI检查•Highresolution,accuracy,3Dreconstruction,andthepossibilityofviewingplanesthatareusuallyinaccessible•Thepossibilityofdetectingandassessingtheinnerstructureofthelesion(hemorrhage,cysts,etc.)•Noionizingradiationisinvolved,whichisespeciallyimportantinchildrenandincasesofmultiplerepeatedexaminationsChangzhengHospitalMRI检查ChangzhengHospitalMRI检查ChangzhengHospitalMRI检查ChangzhengHospitalMRI检查ChangzhengHospital病理检查ChangzhengHospital病理检查ChangzhengHospital甲状腺炎ChangzhengHospital甲状腺炎ChangzhengHospital甲状腺结核ChangzhengHospital甲状腺滤泡状腺瘤ChangzhengHospital分化型甲状腺癌ChangzhengHospital甲状腺乳头状癌ChangzhengHospital甲状腺乳头状癌ChangzhengHospital甲状腺乳头状癌ChangzhengHospital甲状腺乳头状癌ChangzhengHospital甲状腺乳头状癌ChangzhengHospital甲状腺滤泡癌ChangzhengHospital甲状腺滤泡癌ChangzhengHospital低分化甲状腺滤泡癌ChangzhengHospital甲状腺髓样癌ChangzhengHospital甲状腺髓样癌ChangzhengHospital甲状腺未分化癌ChangzhengHospital甲状腺淋巴瘤ChangzhengHospital甲状腺间质组织肿瘤ChangzhengHospital甲状腺内其它组织来源的肿瘤ChangzhengHospital甲状腺转移癌ChangzhengHospital甲状腺细针抽吸细胞学检查（FNAC）ChangzhengHospital甲状腺细针抽吸细胞学检查（FNAC）ChangzhengHospitalFNACChangzhengHospitalFNACChangzhengHospital甲状腺结节诊断流程ChangzhengHospital甲状腺癌的分期ChangzhengHospital淋巴结ChangzhengHospital淋巴结ChangzhengHospital淋巴结ChangzhengHospital淋巴结ChangzhengHospital甲状腺结节的治疗•手术•同位素、放疗（外照射）、化疗•激光射频•酒精硬化ChangzhengHospital病例报告1ChangzhengHospital病例报告2ChangzhengHospital病例报告2ChangzhengHospital病例报告2ChangzhengHospital病例报告2ChangzhengHospital病例报告3ChangzhengHospital病例报告3ChangzhengHospital病例报告3ChangzhengHospital病例报告3ChangzhengHospital病例报告3ChangzhengHospital病例报告3ChangzhengHospital病例报告3ChangzhengHospital病例报告4ChangzhengHospital病例报告4ChangzhengHospital