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乳头溢液的个体化诊断流程

Analysis on Diagnosis and Treatment of Chronic Thyroiditis Complicated with Subacute Thyroiditis

目的　探讨慢性甲状腺炎合并亚急性甲状腺炎患者的临床特征，明确其诊断方法，以减少临床误诊率。方法　回顾性分析2008年6月至2009年12月期间吉林大学中日联谊医院甲状腺外科行手术治疗的5例慢性甲状腺炎合并亚急性甲状腺炎患者的临床资料，包括病史、症状、体征、临床诊治过程、临床辅助检查结果（甲状腺功能检查、彩色多普勒超声检查、核素扫描等）的特点及病理特征。结果　5例患者中仅1例患者术前伴有间断发热和颈部疼痛病史，另外4例患者均无甲状腺炎的典型临床表现。5例患者临床诊治过程较长，病程迁延，平均病程6.8个月，药物对症治疗效果欠佳，症状及彩色多普勒超声检查结果无明显改善，均因术前不能除外恶变情况而行手术治疗。术中及术后病理检查结果均证实为慢性甲状腺炎合并亚急性甲状腺炎。结论　慢性甲状腺炎合并亚急性甲状腺炎临床诊断较困难，病程迁延，易被误诊，必要时可行穿刺病理学检查以明确诊断。

Neck Lymph Node Metastasis and Related Factors in Thyroiditis Coexisting Thyroid Cancer

ObjectiveTo investigate the condition of neck lymph node metastasis and related factors in thyroiditis coexisting thyroid cancer, and make clear the indication of neck lymph node dissection. MethodsA retrospective cohort study was conducted with the clinical data of 147 patients with thyroiditis coexisting thyroid cancer who underwent radical resection of thyroid cancer (total thyroidectomy or subtotal thyroidectomy) and neck lymph node dissection, including age, gender, tumor size, number of focuses, and lymph node metastasis. Results Among 147 patients, 65 patients with neck lymph node metastasis (44.22%), central cervical lymph node metastasis rate was 36.05% （53/147）， which was higher than that of lateral lymph node metastasis rate (20.41%, 30/147), Plt;0.05. Neck lymph node metastasis rate was correlated with patient’s gender and tumor size （Plt;0.05）, while it was not correlated with patient’s age and number of focuses (Pgt;0.05). ConclusionCentral neck lymph node metastasis rate is higher in patients with thyroiditis coexisting thyroid cancer, then routine prophylactic central neck lymph node dissection is significant. Patient’s gender and tumor size are correlated with neck lymph node metastasis. When tumor is larger or in male, ipsilateral lymph node dissection should be considered to done.

超声辅加绘图技术在继发性甲状旁腺功能亢进手术前定位中的应用价值

目的探讨超声辅加绘图技术对继发性甲状旁腺功能亢进甲状旁腺术前定位的效果。方法前瞻性收集 2017 年 6 月至 2018 年 6 月期间在吉林大学中日联谊医院甲状腺外科行手术治疗的继发性甲状旁腺功能亢进患者 20 例，术前由术者亲自操作超声检查。前 5 例（超声组）仅行超声检查，后 15 例（超声辅加绘图组）采取超声辅加手绘标记技术，记录术前定位与术中甲状旁腺位置的符合率。结果超声组的超声识别率为 77.78%（14/18），病理诊断符合率为 100%（18/18）；超声辅加绘图组的超声识别率为 93.85%（61/65），病理诊断符合率为 100%（65/65）。2 组的超声识别率比较差异有统计学意义（χ2=0.850，P<0.05），超声辅加绘图组的超声识别率较高。超声组患者的手术时间长于超声辅加绘图组（t=0.876，P=0.041）。2 组患者术后均未出现喉返神经损伤，术后复查喉镜均未出现声带麻痹。结论对继发性甲状旁腺功能亢进患者，术前超声辅加绘图技术定位甲状旁腺快速而准确，在临床制定手术方案、术中精准切除甲状旁腺及缩短手术时间方面有一定的应用价值。

Significance of UltrasoundGuided Core Needle Biopsy in Diagnosis of Thyroid Nodules

ObjectiveTo explore the value of ultrasound-guided core needle biopsy (CNB) in diagnosis of thyroid nodules. MethodsThe clinical data of 347 patients with thyroid nodules who underwent ultrasoundguided CNB were retrospectively analyzed, and the results of CNB pathology were compared with postoperative wax pathology results. ResultsAll patients completed CNB successfully and satisfaction rate for tissue samples was 100%. After CNB, local hematoma occurred in two cases and relieved by conservative therapy. The CNB pathology results of 347 cases of patients were as follows: 117 cases were malignancy, including papillary thyroid cancer in 115 cases, undifferentiated adenocarcinoma in 1 case, and squamous cell carcinoma in 1 case; 230 cases were benign, including thyroiditis in 53 cases, and nodular goiter in 141 cases, adenoma in 16 cases, and nodular goitre coexisting thyroiditis in 20 cases. In 132 cases of patients underwent surgery including 113 cases of malignancy and 19 cases of benign disease, the CNB pathology results in 127 cases were consistent with postoperative wax pathology results and false negative occurred in 5 cases. The diameter of thyroid nodules were not more than 0.5 cm in 4 cases, 0.5-1.0 cm in 59 cases, 1-2 cm in 46 cases, and more than 2 cm in 23 cases, and the accuracy rate of CNB pathology results was 75.0%（3/4）, 98.3%（58/59）, 97.8%（45/46）, and 91.3%（21/23）, respectively, which was the highest in 0.5-2.0 cm. The accuracy, sensibility, specificity, positive predictive value, negative predictive value, failure rate, and misdiagnosis rate of ultrasound-guided CNB for differential diagnosis of thyroid malignant nodules from benign nodules were 96.21% (127/132), 95.76% (113/118), 100% (14/14), 1 (113/113), 0.74 (14/19), 4.24%(5/118), and 0 (0/14), respectively. ConclusionUltrasound-guided CNB has important value on differential diagnosis of thyroid nodules, and important guiding significance on treatment of thyroid diseases.

Long-Term Primary Culture of Human Papillary Thyroid Carcinoma Cells

ObjectiveTo investigate the primary culture method of human papillary thyroid carcinoma (PTC) cells for a long term and establish a monitoring and verification measures. MethodsPTC cells were isolated following routine procedures and cultured in the DMEM supplemented with 10% fetal bovine serum, glutamine, and 20 ng/ml epidermal growth factor (EGF). Thyroglobulin (Tg) and thyroperoxidase (TPO) in nutrient solution and specific antigen Tg expression of PTC cells cultured for different days were observed. ResultsThe PTC cells grew satisfactorily up to 45 days of incubation. Tg content in nutrient solution expressed the training period of a linear singular parabolic, achieved peak value (985.2 μg/L) at about 14 d. TPO had not been detected in nutrient solution. The Tg expressed positively by immunization fluorescent dyeing. ConclusionsPTC cells cultured in the present method can survive to over 45 days. A brief monitoring and evaluation systems of PTC cells has been established. This report prompts that cultured cells within 14 days maybe more suitable to gene research and provide alternative to the basic research of PTC events and features.