多层螺旋CT对儿童甲状腺肿瘤的诊断和鉴别诊断价值

目的探讨儿童甲状腺肿瘤的CT表现特征及良、恶性病变的鉴别要点。方法回顾性分析经手术和病理证实的32例儿童甲状腺肿瘤的CT表现。采用平扫和增强CT,分析肿瘤的边界、密度和强化程度以及颈部淋巴结转移情况。结果 32例患儿中包括20例单发甲状腺肿瘤、10例多发甲状腺肿瘤,以及2例甲状腺炎伴肿瘤。20例单发肿块中包括腺瘤17例、腺癌3例。腺瘤中9例为实性肿块、8例为囊实性肿块。边界不清、密度不均、包膜不完整均见于腺瘤和腺癌,肿块明显不均匀强化和淋巴结肿大仅见于腺癌病例。多发肿块10例,其中腺瘤6例、腺癌4例。多发微腺癌可表现为甲状腺弥漫性病变。4例多发腺癌中,3例伴淋巴结增大、1例血管侵犯。亚急性甲状腺炎伴发腺瘤1例,双侧桥本甲状腺炎伴发腺癌1例。结论在甲状腺单发病灶中,肿块的强化方式和颈部淋巴结转移对于腺癌诊断具有特异性。在多发病灶中,CT对于显示甲状腺多发微腺癌有局限性。     

儿童甲状腺癌的临床特点及治疗分析

目的探讨儿童甲状腺癌的临床特点及治疗方法。方法回顾分析2003年1月至2014年1月诊断和治疗的19例14岁以下甲状腺癌患儿的临床资料。结果 19例患儿中,男12例,女7例;乳头状癌18例,滤泡状癌1例。行甲状腺峡部加一侧腺叶切除术6例,甲状腺次全切除术4例,甲状腺全切除术9例;单侧颈淋巴结清扫5例、双侧11例。术后病理证实多灶者9例,包膜受侵者14例,淋巴结转移者15例,远处转移5例。所有患儿术后均行促甲状腺激素抑制,10例行131I治疗。中位随访时间63个月,无死亡病例;2例局部残叶肿瘤复发,2例出现颈部淋巴结转移,1例出现远处转移。结论儿童甲状腺癌多为分化型甲状腺癌,总体预后较好,但包膜外侵、两叶多灶、颈部淋巴结及远处转移的高风险患儿需选择甲状腺全切为主的综合治疗方案。     

小儿卵巢肿瘤34例临床分析

目的：了解影响小儿卵巢肿瘤生存率的因素，探讨合理的治疗方案以提高治愈率。方法：３４例小儿卵巢肿瘤患儿为１９７３～１９９５年所收治，年龄４～１４岁，右侧１８例，左侧１６例，其中３例合并蒂扭转。均经手术及病理证实。良性２４例（７０．６％），恶性１０例（２９．４％）。结果：２９例获随访。２４例良性畸胎瘤术后１例复发；２例恶性畸胎瘤术后无瘤生存期分别为６年和２年；３例内胚窦瘤术后均死于肿瘤广泛转移。结论：对于良性卵巢肿瘤主张行患侧附件切除。对于Ⅰ、Ⅱ期恶性肿瘤除行患侧附件切除外，应剖视对侧卵巢，并进行活检、术后化疗及严密随访。对Ⅲ、Ⅳ期恶性卵巢肿瘤强调作根治性手术，尽可能切除原发灶及所有转移病灶，同时术后化疗，以达长期缓解。     

儿童分化型甲状腺癌综合治疗的探讨

目的 探讨儿童甲状腺癌的临床特点及合理的综合治疗方法.方法 回顾性分析了我院2000年1月～2008年1月收治的14岁以下37例分化型甲状腺癌的临床资料.1例甲状腺滤泡状癌仅行双侧甲状腺全切术;36例甲状腺乳头状癌行双侧甲状腺全切,根据肿块及淋巴结的情况行不同范围的颈淋巴结清扫术.手术后根据情况决定131 Ⅰ治疗及TSH抑制治疗的程度.结果 术后并发症总的发生率为5.4%(2/37).术后病理检查97.3%(36/37)为甲状腺乳头状癌,2.7%(1/37)为甲状腺滤泡状癌;多灶性癌的发生率为32.4%;淋巴结转移率为91.9%(34/37).平均随访3.8年,无死亡病例,18.9%(7/37)出现颈淋巴结复发转移,8.1%(3/37)出现远处脏器转移.结论 儿童甲状腺预后较好,治疗应采取双侧甲状腺全切加不同范围颈清扫的手术为中心,结合内分泌治疗和131 Ⅰ内照射治疗的综合治疗.     

儿童甲状腺全切术后低钙血症危险因素分析

目的:探讨儿童甲状腺全切除术后低钙血症的发生率、危险因素和预后。方法:收集2014年1月至2019年12月在上海交通大学医学院附属新华医院行甲状腺全切术的37例患儿的临床资料,其中,男15例,女22例;手术时的中位年龄为12岁（6~17岁）。分析手术方式、病变类型、原位甲状旁腺保留数（parathyroid gland...     

2015年ATA儿童指南用于儿童甲状腺乳头状癌外科治疗的单中心经验

目的探讨2015年美国甲状腺协会(American Thyroid Association, ATA)发布的第一版"儿童甲状腺结节和分化型甲状腺癌管理指南"所推荐的手术方式是否适用于我国儿童乳头状甲状腺癌(papillary thyroid carcinoma, PTC)的外科治疗。方法收集2012年4月至2018年12月在昆明医科大学第一附属医院连续收治并接受初次手术治疗的PTC患儿(≤18岁)42例的临床资料, 其中男5例, 女37例, 年龄(15.1±3.0 )岁, 年龄范围6～18岁。PTC患儿常规行颈中央区淋巴结清扫术(central neck dissection, CND), 对进行全甲状腺切除术的患儿行双侧CND, 但对行甲状腺腺叶及峡部切除的患儿行同侧CND。结果 42例PTC患儿中, 69.05%为单灶癌(29/42), 30.95%(13/42)为多灶癌。单侧癌76.19%(32/42), 双侧癌23.81%(10/42)。T1, T2, T3和T4病变分别为38.10% (16/42), 19.05%(8/42), 23.81%(10/42)和19.05%(8/...     

经支气管镜介入治疗儿童原发性气道肿瘤八例分析

目的了解儿童气道肿瘤经支气管镜介入治疗的可行性。方法对2016年11月至2018年3月在首都医科大学附属北京儿童医院住院经支气管镜介入治疗的8例原发性气道肿瘤患儿的临床表现、介入治疗结果和预后情况进行回顾性分析。结果8例原发性气道肿瘤患儿中,男5例、女3例,年龄4岁8月龄至9岁2月龄。临床表现主要为咳嗽伴喘息6例、咯血3例和反复肺部感染2例,均无淋巴结转移及肺外转移。8例患儿均经支气管镜介入肿瘤切除,对4例富含血流的肿瘤患儿支气管镜介入治疗术前行肿瘤供血处支气管动脉栓塞术。术中及术后未发生大出血、气胸等并发症。4例为低度恶性支气管黏液表皮样癌,2例为炎性肌纤维母细胞瘤,1例为多形性腺瘤,1例为支气管平滑肌梭形细胞瘤。术后随访2~4年,复发3例,其中2例炎性肌纤维母细胞瘤患儿中,1例因病灶位置深行外科切肺治疗,1例联合化疗治疗后病灶稳定;1例黏液表皮样癌介入冷冻治疗后随访中。结论儿童气道肿瘤临床表现不典型,主要有干咳、喘息、反复肺部感染和咯血等症状。经支气管镜下介入治疗儿童气道内良性和低度恶性肿瘤,是一种可行的选择。     

儿童脊柱肿瘤

目的 探讨儿童脊柱肿瘤的临床特点、诊断、治疗方法及预后。方法回顾性分析我院1991年1月-2003年10月治疗的16岁以下脊柱肿瘤及瘤样病变44例，男27例，女17例；平均9．6岁。良性肿瘤（包括瘤样病变）38例，恶性肿瘤3例，转移瘤3例。疼痛39例，肿块9例，侧弯或斜颈8例，不同程度神经损害14例。18例初诊不确定或与最后诊断不符。发病至确诊时间平均8．5个月。手术治疗17例，化疗10例，放疗8例，手术与化疗1例，手术与放疗2例，放弃治疗3例，观察3例。结果围手术并发症4例。35例获平均5．5年随访。良性肿瘤及瘤样病变患儿手术或放疗或化疗后疗效较满意，所有患儿的局部疼痛消失，除1例外，所有患儿神经功能均有改善，3例病变复发再次手术。4例出现后弯畸形。6例恶性肿瘤和转移瘤患儿全部死亡。2例嗜酸性肉芽肿患儿症状消失，病变得到控制。结论对于儿童脊柱肿瘤，根据肿瘤的性质选择恰当的治疗方法，良性肿瘤与肿瘤样病变预后良好，恶性肿瘤及转移瘤治疗效果欠佳。     

经支气管镜介入治疗儿童原发性气道肿瘤八例分析

目的了解儿童气道肿瘤经支气管镜介入治疗的可行性。方法对2016年11月至2018年3月在首都医科大学附属北京儿童医院住院经支气管镜介入治疗的8例原发性气道肿瘤患儿的临床表现、介入治疗结果和预后情况进行回顾性分析。结果 8例原发性气道肿瘤患儿中,男5例、女3例,年龄4岁8月龄至9岁2月龄。临床表现主要为咳嗽伴喘息6例、咯血3例和反复肺部感染2例,均无淋巴结转移及肺外转移。8例患儿均经支气管镜介入肿瘤切除,对4例富含血流的肿瘤患儿支气管镜介入治疗术前行肿瘤供血处支气管动脉栓塞术。术中及术后未发生大出血、气胸等并发症。4例为低度恶性支气管黏液表皮样癌,2例为炎性肌纤维母细胞瘤,1例为多形性腺瘤,1例为支气管平滑肌梭形细胞瘤。术后随访2～4年,复发3例,其中2例炎性肌纤维母细胞瘤患儿中,1例因病灶位置深行外科切肺治疗,1例联合化疗治疗后病灶稳定;1例黏液表皮样癌介入冷冻治疗后随访中。结论儿童气道肿瘤临床表现不典型,主要有干咳、喘息、反复肺部感染和咯血等症状。经支气管镜下介入治疗儿童气道内良性和低度恶性肿瘤,是一种可行的选择。     

12例儿童甲状腺癌的临床诊断和治疗分析

目的：该研究旨在探讨儿童甲状腺癌的临床特点、诊断和治疗方法。方法：回顾性分析1998年8月至2008年8月在中南大学湘雅二医院乳腺甲状腺外科及小儿外科收治的14岁以下12例儿童甲状腺癌患者的临床资料。结果:儿童甲状腺癌与儿童良性甲状腺肿块首发症状均为无痛性肿块,但在肿块质地和颈淋巴结转移上差异有显著性（P＜0.05）。术前B超检查诊断符合率为75%,CT检查诊断符合率为83%,两者之间差异无显著性（P＞0.05）。病理诊断均为分化型甲状腺癌,其中乳头状癌7例,滤泡状癌3例,乳头状癌合并滤泡状癌2例。所有患者均行手术治疗及术后内分泌治疗,未行131I内放射治疗。手术方式主要选择单侧腺叶加峡部切除, 行功能性颈淋巴结清扫术10例（83%）,颈淋巴结转移者9例（75%）。中位随访时间5年8个月（2个月至10年）,5年及10年总生存率均为100%。结论：儿童甲状腺癌多为分化型,临床症状以质地坚硬及淋巴结转移多见为其特征,B超及CT检查结合可提高诊断甲状腺癌的准确性。选择合理治疗方案能取得满意疗效。［中国当代儿科杂志,2009,11（2）：120-123］     

Ultrasound imaging in diffuse thyroid disorders of children

The diagnosis of diffuse thyroid disorders in children is based mainly on hormone and antibody determinations and a cytologic sample taken by aspiration biopsy. The cytologic sample is not always obtainable in small children or when the thyroid gland is not enlarged. Thyroid antibodies lead to diagnosis only in a proportion of cases. Gamma imaging is not recommended in children because of the radiation risk. The aim of this study was to demonstrate that ultrasound imaging can detect diffuse thyroid disorders in children. Ultrasound images were abnormal in 92% of all subjects; they were abnormal in 97% of cases with thyroiditis and in most cases ultrasound was diagnostic. With antibody determinations, only 60% of the cases of thyroiditis could be diagnosed. Ultrasound imaging--a risk-free method--should be included in the diagnostic investigation of thyroid disorders.     

Ultrasound Imaging in Diffuse Thyroid Disorders of Children

ABSTRACT. The diagnosis of diffuse thyroid disorders in children is based mainly on hormone and antibody determinations and a cytologic sample taken by aspiration biopsy. The cytologic sample is not always obtainable in small children or when the thyroid gland is not enlarged. Thyroid antibodies lead to diagnosis only in a proportion of cases. Gamma imaging is not recommended in children because of the radiation risk. The aim of this study was to demonstrate that ultrasound imaging can detect diffuse thyroid disorders in children. Ultrasound images were abnormal in 92 % of all subjects; they were abnormal in 97 % of cases with thyroiditis and in most cases ultrasound was diagnostic. With antibody determinations, only 60 % of the cases of thyroiditis could be diagnosed. Ultrasound imaging–a risk-free method-should be included in the diagnostic investigation of thyroid disorders.     

Multinodular goiter in children.

OBJECTIVE: As multinodular goiter (MNG) is an uncommon pediatric disorder, we decided to evaluate the children with this diagnosis at our center to try to delineate better its etiology, the risk of malignancy and appropriate management strategies. METHODS AND RESULTS: Eighteen patients (12 girls and 6 boys) were the subject of this retrospective review spanning a period of 20 years. All were previously well, except one, and none had had head or neck irradiation. Average age at diagnosis was 12.8 years. Four children belonged to two previously identified kindreds diagnosed with familial MNG. These families had members affected with multiple cases of non-medullary thyroid carcinoma (NMTC). All were euthyroid and had no symptoms. In eight of 18 patients, the clinical examination missed the presence of multiple nodules which were subsequently detected by ultrasound. Twelve patients had tissue diagnosis by fine needle aspirate cytology (FNAC) or surgery. Five of eight patients undergoing surgery had nodular hyperplasia, one had a follicular adenoma and one had a normal thyroid gland on histology. There was one patient with papillary carcinoma combined with nodular hyperplasia. Seven of the patients had evidence of antithyroid autoimmunity. CONCLUSION: The etiology of pediatric MNG appears multifactorial including autoimmune and familial factors. We believe that previously healthy children can usually be managed conservatively. Ultrasound at the time of diagnosis and in follow up seems beneficial. Familial forms appear to warrant close follow up, given the apparent increased risk of malignancy. The risk of malignancy while low remains real.     

Importance of thyroglobulin levels for diagnosis and monitoring of follicular thyroid carcinoma in an adolescent with severe iodine deficiency

Optimal management of differentiated thyroid cancer in childhood is undetermined. During monitoring of thyroid carcinoma, serum thyroglobulin (hTG) levels provide valuable information. hTG levels not only increase in differentiated thyroid cancers but also in iodine deficiency because of compensation by the thyroid gland. A 14.6 year-old girl was diagnosed with nodular goiter, subclinical hypothyroidism and severe iodine deficiency. She had a very high hTG level. Despite benign fine-needle aspiration biopsy (FNAB), because the hTG level was still very high after treatment with LT4, thyroidectomy was undergone. Cytopathological examination showed minimally invasive follicular thyroid carcinoma. During follow-up, to exclude the presence of persistent/recurrent disease, the hTG level rose to an undesirably high level after withdrawal of TSH suppressive therapy, and radioiodine ablation therapy was applied. This report shows that even if there is an explanation for nodular goiter and high hTG levels, such as iodine deficiency, malignancy cannot be ruled out without thyroidectomy. FNAB is not reliable especially in iodine deficient areas. Serum hTG measurement is a valuable tool for both diagnosis and follow-up of differentiated thyroid carcinoma in children.     

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??Objective??To evaluate the diagnostic and therapeutic value of flexible bronchoscopy in children with necrotizing pneumonia. Methods??Clinical data of children diagnosed with necrotizing pneumonia in the Department of Pediatrics of the First Hospital of Jilin University from December 2016 to December 2017 were collected. The general clinical manifestations??laboratory examination results??chest X-ray or lung CT??flexible bronchoscope and other examinations of all the children were analyzed retrospectively. Based on the characteristics??diagnosis??treatment and prognosis??the advantages of flexible bronchoscopy in this disease were analyzed. Results??All the 32 cases were diagnosed as necrotizing pneumonia by imaging examination??with an average diagnosis time of 14.1 d. All 32 cases of children with necrotizing pneumonia received flexible bronchoscopy and alveolar lavage. The alveolar lavage in 32 cases presented turbidity mitota-like changes??which had high sensitivity in the diagnosis of necrotizing pneumonia. The average time for mitota-like changes in alveolar lavage was 6.7 days. Conclusion??Flexible bronchoscopy is an important method in the diagnosis and treatment of necrotizing pneumonia??and the change of alveolar lavage fluid is a sensitive index for early prediction of necrotizing pneumonia.     

Papillary carcinoma thyroid: FNAC diagnosis

Thyroid carcinoma in children is currently assuming greater importance due to increase incidence in the recent times. In carcinoma thyroid, the age at the time of diagnosis is an important prognostic factor and children in particular are considered to have an excellent prognosis. We came across 3 cases of papillary carcinoma thyroid involving both the lobes and having lymph node metastasis in children, the youngest being 4 years of age at the time of diagnosis. All these cases were diagnosed on aspiration cytology.     

儿童慢性淋巴细胞性甲状腺炎的诊断探讨

为探讨儿童弥漫性甲状腺肿的简便和精确的诊断方法，对已经细针穿刺细胞学检查和甲状腺自身抗体检测的５０例弥漫性甲状腺肿患儿同时应用Ｂ超进行了甲状腺扫描检查，以１０９名７～１４岁正常儿童的甲状腺超声影像作对比。结果：正常儿童甲状腺的影像为略强于其周围肌肉组织的均匀回声图；弥漫性甲状腺肿患儿的甲状腺体积明显大于正常同龄儿童；细胞学确诊为慢性淋巴细胞性甲状腺炎的２６例中２２例（８４．６％）Ｂ超回声图像呈大小不等的低回声区改变，其中１８例（８１．８％）伴自身抗体阳性；而细胞学诊断为甲状腺弥漫性增生的２４例患儿中则１７例（７０．８％）Ｂ超回声图像正常，仅７例（２９．１％）呈异常回声图，且均伴自身抗体阳性，其中２例１年后细胞学复查证实为慢性淋巴细胞性甲状腺炎。Ｂ超结合自身抗体的检测与细胞学检查的诊断符合率为９２％。提示：Ｂ超作为一种简便易行、无创伤、可反复进行的检查手段，辅以血清学检测，对儿童慢性淋巴细胞性甲状腺炎的诊断有较好的实用价值。     

Long-term outcome of hormonal status in Taiwanese children with Hashimoto’s thyroiditis

The objective of this prospective study was to evaluate both thyroid function in children with Hashimoto’s thyroiditis and the necessity of lifetime thyroxine replacement therapy. A total of 47 patients with goiter and positive thyroid auto-antibodies participated in the study. Serum thyroxine and thyrotropin levels and titers of thyroid auto-antibodies were checked regularly throughout the follow-up period. At the beginning of the study, 25 patients were diagnosed as euthyroid, but at the end of the study, 22 patients initially diagnosed with euthyroidism remained euthyroid, while eight patients with subclinical hypothyroidism and three patients with overt hypothyroidism had become euthyroid. Thus, of the 22 patients with thyroid dysfunction at diagnosis, subclinical or overt, 11 became euthyroid during the follow-up period. The effect of thyroxine treatment on thyroid auto-antibody titers was not significant. Conclusion: Our data shows that Hashimoto’s thyroiditis in children has a benign course and that thyroid function in one half of the patients with thyroid dysfunction at diagnosis reverts to normal. Careful follow-up of thyroid function is important in order to determine the necessity and timing of thyroxine replacement therapy.     

超声诊断和水压灌肠治疗小儿肠套叠

目的：　评价超声诊断和超声监视下水压灌肠治疗小儿急性肠套叠的方法和疗效。方法：　对173例可疑肠套叠患儿进行超声检查,发现有“同心圆”征的同时在超声监视下进行水压灌肠复位治疗。结果：　超声确诊肠套叠32例,诊断准确率100%,其中30例水压灌肠复位成功,复位成功率93.8%。3例回回结型中1例水压灌肠成功,2例失败改手术治疗。结论：　超声诊断小儿肠套叠准确率高,水压灌肠复位成功率高。对回回结型超声可以确诊,但复位成功率低