甲状腺结节：95%为良性 Thyroid nodule：For benign 95%

专家指出：超过1.5厘米建议手术 Experts point out that：More than 1.5 centimeters suggest surgery

受访专家/中山大学附属第一医院甲状腺乳腺外科副教授 刘大钺 The expert and sun yat-sen university said the first hospital affiliated thyroid breast surgical associate professor liu huge ye-tomahawk

　　最近，不少人在单位的例行体检中发现甲状腺结节，紧张之余又深感困惑，因为有些体检医生会劝说这样的病人手术治疗，也有医生说甲状腺结节十分常见，不必太在意。这样一来，很多病人就没有了方向。到底如何处理这个结节，一定要切除吗？记者就此请甲状腺专家给予详细解答。

recent，Many people in the unit found in routine check-up of thyroid nodule，Nervous and deeply confused over，Because some medical doctor will persuade such patient surgery，Also have the doctor said thyroid nodules are very common，Don't too concerned about。so，Many patients have no direction。Exactly how to deal with the nodules，Must be removed？Reporter on thyroid experts to give a detailed answer, please。

小的良性甲状腺结节 Small benign thyroid nodules

密切观察！ Closely observe！

　　“在看门诊的时候，经常会碰到病人拿着体检报告前来咨询甲状腺结节的问题。”中山大学附属第一医院甲状腺乳腺外科副教授刘大钺说，这说明甲状腺结节十分普遍。统计数据显示：甲状腺结节患病率高达18.6%，女性更为多见，男女比例为1：4。多数甲状腺结节形成后，病人并没有特别的感觉，通常是在体检过程中通过B超给查出来的，只有结节较大时，病人才容易自己触摸发现。

“Looking at the outpatient service，Often met patients take medical report to come to consult the thyroid nodule problem。”Affiliated hospital of sun yat-sen university first breast surgical associate professor liu thyroid huge ye-tomahawk said，It shows that the thyroid nodules are common。Statistics show that：Thyroid nodule rates as high as 18.6%，Women more frequently，Sex ratio of 1：4。Most of thyroid nodule formation，Patient and no special feelings，Usually on the physical examination process through the B to exceed to found out，Only when the larger nodules，The patient just easy to find his touch。

　　体检中发现甲状腺结节不用过度恐慌，切勿盲目要求做手术。对于小结节，及时到医院专科就诊并定期随访是十分必要的。刘教授建议，发现有结节的患者，如果结节的直径小于1cm，每半年或一年做一次甲状腺超声检查，密切观察即可。如果提示有钙化，必要时可进行组织细胞活检，这才是甲状腺结节确诊的金标准。

Physical examination found in thyroid nodule don't panic，Do not blindly requirements for surgery。For small nodules，In time to hospital received diagnoses and regular follow-up is very necessary。Professor liu suggested，Find a nodule of patients，If the nodules are less than 1 cm in diameter，Every six months or a year for a thyroid ultrasound，Close observation can。If suggesting the calcification，When necessary for organization cells biopsy，This is the gold standard of thyroid nodule diagnosis。

　　近几年，临床调查报告结果显示，95%的甲状腺结节都为良性病变，甲状腺癌仅占5%。对于良性结节，首选内科保守治疗，比如口服药物缩小结节，或者局部注射、超声消融等。

In recent years，Clinical investigation report results are shown，95% of the thyroid nodules are benign lesions，Thyroid cancer accounted for only 5%。For benign nodules，Preferred medical therapy，Such as oral drug narrow nodules，Or local injections of、Ultrasound ablation, etc。

超过1.5cm厘米或有钙化的结节 More than 1.5 cm centimeters or calcified nodule

建议手术！ Suggest surgery！

　　出现甲状腺结节，不少病人心理压力非常大，以为结节等同于癌症，便马上到甲状腺外科要求医生为其开刀切掉。

Thyroid nodules appear，Many patients psychological pressure is very big，Think nodules is equivalent to cancer，He immediately to the thyroid surgery requested the doctor operated on for the cut off。

　　甲状腺结节是否要手术，要看其大小以及是否有钙化，如果有恶变的可能，就要及早手术。刘大钺说，曾接诊一个26岁的女患者，体检发现右侧甲状腺有一个直径1.6厘米的结节并且伴有钙化。由于这种单发结节合并钙化极可能有恶变，当即建议她手术治疗，但她回单位一问，同事中也有好几个查出大小不等的甲状腺结节，于是她也就不当回事。幸好在家人的催促下，这位女患者才到医院进行了手术，结果，病理检查提示为“右侧甲状腺乳头状癌”。尽管是恶性肿瘤，由于治疗及时，手术切除后，至今五六年都没事，结婚生子一切正常。

Thyroid nodule whether to surgery，To see its size and whether any calcification，If there is the possibility of malignant change，Will early operation。Liu huge ye-tomahawk, said，Once accepts a 26-year-old female patients，Physical examination found the right thyroid has a diameter of 1.6 centimeters of nodules and with calcification。Because this is a single merger is likely to have calcified nodule evil change，Promptly suggested that she surgery，But her back to ask unit，In the colleague also have several found the sizes of thyroid nodule，So she would take it lightly。Fortunately, in the family's urged，The female patients to hospital for the operation，The results，Pathological examination of the for“The right thyroid papillary carcinoma”。Although is malignant tumors，Because treatment in time，After surgical resection，So far five or six years is all right，Get married and have children all normal。

　　刘教授称，一般来讲，直径在1cm-1.5cm之间的结节可先用甲状腺素制剂治疗6-9个月，如果结节缩小或未继续增大，可暂不手术，继续观察。直径超过1.5cm的则建议手术。但对B超发现有砂粒样钙化或穿刺发现有乳头状增生或怀疑癌的结节，那么，不管结节大小都必须及早手术。

Professor liu says，Generally speaking，1 cm in diameter-1.5 cm of between nodules can use first thyroxine preparation treatment 6 to 9 months，If the nodules narrow or not continue to increase，Can temporarily not the operation，Continue to watch。More than 1.5 cm in diameter of surgery is recommended。But to B super found with the granular appearance calcification or puncture found papillary hyperplasia or doubt cancer nodules，so，No matter the size must early operation nodules。

　　一旦穿刺确诊为甲状腺癌，只要是未分化型，还是容易治疗的，因为这类癌很少转移，并且对放射性同位素治疗非常敏感，预后良好，生存期甚至和正常人没差别。因此，大家不必对甲状腺结节过于紧张。

Once the puncture diagnosis of thyroid cancer，As long as it is not differentiated type，Or easy to treat，Because this type of cancer metastasis，And radioactive isotopes are very sensitive to treatment，Prognosis is good，Surial even and normal person didn't difference。so，You don't have to thyroid nodule too nervous。

术后为何会出现声嘶或甲减 Postoperative why will the screamed at or JiaJian

　　对于甲状腺结节的手术，有不少患者有诸多疑虑，除了脖子上会有一条“自杀”式的疤痕外，有人还因为手术后复发，一年开了两三刀。

For thyroid nodule of surgery，Many patients have many doubts，In addition to the neck and will have a“suicide”Type of the scar，There are some after surgery for recurrence，A year opened two or three knife。

　　刘教授称，临床上最常见的甲状腺良性结节就是结节性甲状腺肿，病程较长的患者几乎整个甲状腺都存在病变结节。因此，当结节比较大时，手术切除范围不够彻底，则很有可能残留增生的甲状腺组织和微小结节，这就为复发埋下了隐患。一旦这些小结节长大，就说明复发了。由于复发后手术的风险要比初次手术高5-10倍，所以，一旦患者甲状腺结节特别大又很多的时候，为了尽量避免患者手术后复发，医生可能会尽量扩大结节切除的范围，这样就不可避免地导致永久性甲减的发生，在手术后需要终身补充甲状腺素制剂，以维持正常的甲状腺功能。

Professor liu says，The most common clinical thyroid nodule is benign nodular thyroid is swollen，Had a long patients have almost the entire thyroid lesion nodules。so，When nodules is large，Surgical resection not thorough enough range，It is likely to remain the thyroid and tiny hyperplasia nodules，This is the recurrence buried the hidden trouble。Once these small nodules grow up，That relapse。Because of the risk of recurrence after surgery than first surgery high 5-10 times，so，Once the patient of thyroid nodule especially big and a lot of time，In order to avoid patients relapse after surgery，A doctor may try to expand the scope of the nodule resection，This inevitably leads to the permanent JiaJian occurs，After surgery require lifelong added thyroxine preparations，To maintain normal thyroid function。

　　另外，术后可能出现声音嘶哑的并发症，这是因为切除甲状腺结节手术时，可能会引起喉返神经的水肿或影响它的血供，以至于术后出现说话比较吃力的现象。但这一现象会随着水肿的消退和血供的恢复而在术后3个月左右逐渐消失。(文/记者 张华 通讯员 李绍斌 彭福祥)

In addition，Postoperative complications may occur hoarse voice，This is because resection of thyroid nodule surgery，May cause of recurrent laryngeal nerve swelling or affect its blood supply，There are hitting the talk that the phenomenon。But this phenomenon will with the resolve and edema blood supply of recovery in the first 3 months or so gradually disappear。(Wen/reporter zhang hua correspondent LiShaoBin PengFuXiang)