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桥本甲状腺炎(HT)合并甲状腺癌的发病率逐年增高,尤其以合并乳头状微小癌(PTMC)最多见。HT的炎性微环境中的免疫反应既可为PTMC的诱因,又可对PTMC的进展起抑制作用,故HT合并PTMC时仍主张外科处理,但其手术时机和手术范围尚存争议。HT合并PTMC时手术应在遵循指南的基础上,强调个体化诊疗。一般对于单侧叶单发PTMC且无高危因素者,主张行患侧腺叶+峡部切除术;对于HT病史长、甲状腺自身抗体和促甲状腺激素(TSH)水平明显升高、证实双侧多灶癌、伴有颈淋巴结转移或已有远处转移者,则须行全甲状腺切除术。在行腺叶切除同时,应行同侧中央区淋巴结清扫;对于颈侧区肿大淋巴结,原则上在获取证据后再行清扫。由于合并HT时甲状腺腺体增大、易出血、中央区淋巴结增生,使手术难度增高,喉返神经及甲状旁腺损伤风险增加,故强调综合应用现代外科技术以提高手术安全性。
Hashimoto’s thyroiditis (HT) combined with the incidence of thyroid cancer increased year by year, especially with the most common papillary micro-cancer (PTMC). The immune response in the inflammatory microenvironment of HT is not only the inducement of PTMC but also inhibits the progression of PTMC. Therefore, surgical treatment is still advocated when HT is combined with PTMC, but the timing and scope of surgery are still controversial. HT combined with PTMC surgery should follow the guidelines, based on the emphasis on individualized diagnosis and treatment. General unilateral single-sided PTMC with no risk factors, advocated the ipsilateral ipsilateral lobectomy and lobectomy; for a long history of HT, thyroid autoantibodies and thyroid stimulating hormone (TSH) levels were significantly increased, confirmed bilateral multifocal Cancer, with cervical lymph node metastasis or distant metastasis who have undergone total thyroidectomy. In the line of gland lobectomy at the same time, the ipsilateral central lymph node dissection should be performed; for the neck side of the enlarged lymph nodes, in principle, to obtain evidence before cleaning. Due to the enlargement of thyroid gland, hemorrhage and central lymph node hyperplasia, the surgical difficulty is increased and the risk of recurrent laryngeal nerve and parathyroid gland is increased. Therefore, it is emphasized that the comprehensive application of modern surgical techniques to improve the safety of surgery.