Surgical Treatment of Hurthle Cell Tumors of the Thyroid
Surgical Treatment of Hurthle Cell Tumors of the Thyroid
复制标题
甲状腺梭细胞瘤的手术治疗
DOI：
10.1007/s00268-004-7669-9
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发表时间：
2005
影响因子：
2.6
通讯作者：
Miin‐Fu Chen
中科院分区：
文献类型：
--
作者：
T. Chao;Jen;Miin‐Fu Chen
Hurthle细胞瘤是相对罕见的甲状腺肿瘤，其管理和预后是有争议的。我们回顾性分析了135例甲状腺Hurthle细胞腺瘤和28例甲状腺Hurthle细胞癌的手术治疗。腺瘤组和癌组在患者年龄、性别和肿瘤大小方面无显著差异。针吸细胞学诊断恶性肿瘤的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为87.5%、19.3%、31.2%、18.6%和88.0%。冰冻切片诊断甲状腺恶性肿瘤的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为40.0%、100.0%、92.9%、100.0%和92.0%。大多数腺瘤的治疗方法不低于肺叶切除术/峡部切除术。同时，大多数甲状腺癌患者行甲状腺全切除术。6例患者（3.8%）发生手术并发症，包括3例患者发生暂时性喉返神经麻痹，2例患者发生上级喉神经外分支损伤，1例患者发生暂时性低钙血症。Hurthle细胞腺瘤无复发。5例腺瘤患者死于与Hurthle细胞瘤无关的原因，但在随访期间没有癌症患者死亡。结论：临床因素及针吸细胞学检查对腺瘤与癌的鉴别诊断无帮助。单侧Hurthle细胞腺瘤可以通过叶切除术/峡部切除术治疗，Hurthle细胞癌可以通过甲状腺全切除术治疗，手术发病率最低。
Hurthle cell tumors are relatively rare thyroid tumors and their management and prognosis is controversial. We retrospectively review 135 Hurthle cell adenomas and 28 Hurthle cell carcinomas of the thyroid surgically treated at our institute. No significant difference was found between the adenoma and carcinoma groups in patient age, gender, and tumor size. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of fine-needle aspiration cytology (FNAC) in detecting malignancy were 87.5%, 19.3%, 31.2%, 18.6%, and 88.0%. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of frozen section in detecting malignancy of the thyroid gland were 40.0%, 100.0%, 92.9%, 100.0%, and 92.0%. Most of the adenomas were treated with procedures no less invasive than lobectomy/isthmusectomy. Meanwhile, most of the carcinoma patients underwent total thyroidectomy. Operative morbidity occurred in six patients (3.8%), including transient recurrent laryngeal nerve palsy in three patients, damage to the external branch of the superior laryngeal nerve in two patients, and transient hypocalcemia in one patient. No recurrence of Hurthle cell adenomas was noted. Five adenoma patients died of causes unrelated to their Hurthle cell tumors, but no carcinoma patients died during the follow-up period. In conclusion, clinical factors and FNAC are not helpful in the differentiation between adenoma and carcinoma. Unilateral Hurthle cell adenoma can be treated by lobectomy/isthmusectomy, and Hurthle cell carcinoma can be treated by total thyroidectomy with minimal operative morbidity.