老年甲状腺结节的临床特点及其诊治经验

Clinical paticularities and experiences in diagnosis and treatment of elderly patients with thyroid nodules

摘要:

目的：探讨老年甲状腺结节的临床特点和诊治方法。 方法：回顾性分析瑞金医院外科自2003年1月—2009年12月间收治的144例大于60岁的老年和1 412例中青年甲状腺结节患者的临床资料。 结果：与中青年组比较, 老年甲状腺结节以多发为主且最大结节的直径都较大; 压迫症状和继发性甲亢是老年者的主要手术指征; 因复发而再次手术的比例高; 老年者术前麻醉ASA评分较低; 对老年组手术主要为在全麻下对双侧多发结节者行双甲近全切除术; 术中发现喉返神经和甲状旁腺有脂肪沉着。病理方面老年者良性结节钙化率较高（P<0.05）; 术后除暂时性低钙血症的发生率较高外(P<0.05）, 其他并发症与中青年者相比无差异(P>0.05)。 结论：只要充分了解老年甲状腺结节的临床特点, 采取合理的治疗方法, 应该可避免老年甲状腺结节者手术的风险和并发症。

Abstract:

Objective：To explore the clinical paticularities and experiences in diagnosis and treatment of elderly patients with thyroid nodules. Methods：The clinical records of 144 patients more than 60 years old and 1412 young or middle-aged patients less than 60 years old with thyroid nodules admitted to Ruijin hospital were retrospectively analyzed. Results：Compared with the young or middle-aged patients, the elderly patients with thyroid nodules presented the following particularities: bilateral and multifocal lesions were the main manifestations and usually with larger nodules in diameters; compression symptoms and secondary hyperthyroidism were the main surgical indications; the reoperation rate was higher due to recurrence; the preoperative ASA score was poor; near-total thyroidectomy for bilateral and multifocal nodules under gereral anaesthesia was the main procedure; fat depositions were frequently found around the recurrent laryngeal and parathyroid glands during surgery, and the calcification rate of benign nodules was high (P>0.05). Except for higher incidence of transient hypocalcemia in the elderly patients, no significant difference was noted in terms of postoperative complication between the clderly and younger patients. Conclusions：In elderly patients with thyroid nodules, the surgical risks or complications can be reduced or avioded as long as their clincal particularities are fully understand and proper treatment is employed.