儿童分化型甲状腺癌术后辅助治疗效果观察

目的探讨儿童分化型甲状腺癌术后辅助治疗效果。方法回顾性分析≤14岁122例分化型甲状腺癌患儿的临床资料。结果 122例手术均顺利完成。24例行单侧甲状腺腺叶切除术,98例行双侧甲状腺全切术,其中72例行选择性颈淋巴结清扫术,26例行根治性颈淋巴结清扫术;所有患者术后均给予左旋甲状腺素钠片治疗,剂量1.5-2.5μg/（kg·d）,使术后促甲状腺激素〈0.1mIU,其中79例辅以131I治疗;所有患儿均获随访,随访时间6个月-10a;患儿身高、体质量均不低于WHO推荐的儿童生长发育标准;随访期间,无死亡病例;11例（9%）出现颈淋巴结转移,5例（4%）出现远处脏器转移;5例肺转移患儿在131I及内分泌辅助治疗后,肺部CT提示有4例转移灶完全消失,1例病灶明显缩小。结论儿童分化型甲状腺癌术后辅以131I内照射和内分泌抑制疗法,可降低肿瘤复发,对转移病灶有较好疗效,明显改善患者预后。

Postoperative auxiliary treatment of differentiated thyroid carcinoma in children

Objective To investigate the therapeutic effect of postoperative adjuvant treatment on differentiated thyroid carcinoma（DTC）in children.Methods The clinical data of 122 patients aged 14 years or younger with DTC were retrospectively analyzed.Results The operations were successfully completed in 122 patients including 24 undergoing unilateral thyroid lobectomy and 98 undergoing bilateral thyroidectomy.Among the patients undergoing bilateral thyroidectomy,72 received selective neck lymphadenectomy and another 26 received radical neck lymphadenectomy.All patients were treated with Euthyrox after operations at the dose of 1.5to 2.5μg/（kg·d）until thyroid stimulating hormone was over 0.1mIU.After operation,79 patients accepted 131 I radioiodine therapy.All patients were followed up for 6 months to 10 years.The height and body mass of all patients reached the standards of development growth recommended by WHO.No death occurred during the follow-up.Lymph node metastases were found in 11patients（9%）and distant metastases were found in 5（4%）.After 131 I and adjuvant endocrine therapy,metastatic lesions in the lung disappeared completely in 4and shrinked obviously in 1.Conclusion The postoperative adjuvant 131 I radioiodine therapy and endocrine suppressive therapy can reduce the risk of tumor recurrence,enhance the treatment effect for metastatic lesion and improve the prognosis of the patients with DTC.