儿童分化型甲状腺癌的临床特征及治疗体会

目的 探讨儿童分化型甲状腺癌的临床特征和治疗特点。 方法 回顾分析经手术治疗的18岁以下的分化型甲状腺癌32例的临床资料。 结果 32例患者中男8例,女24例。发病年龄<14岁11例,≥ 14岁21例;累及双侧甲状腺19例,单侧13例。多发病灶23例,单发病灶9例;肿瘤≥1 cm 30例,<1 cm 2例;病理证实甲状腺乳头状癌27例,甲状腺滤泡状癌5例;发生颈淋巴结转移25例,转移率为78.13%,颈部Ⅰ~Ⅵ区及上纵隔区均有淋巴结转移,各区转移率分别为 3.13%、31.25%、31.25%、37.50%、9.38%、68.75%、25.00%;发生甲状腺外侵12例,肺转移5例,甲状腺癌术后颈部淋巴结转移10例。随访1~14年,无死亡病例。 结论 儿童分化型甲状腺癌具有侵袭性强、转移率高、复发率高、死亡率低的临床特点,甲状腺全切除术和规范的颈结清扫术值得高度重视。

Clinical characteristics and treatment of differentiated thyroid carcinoma in children.

Objective To explore the clinical characteristics and treatment of thyroid carcinoma in children and adolescents. Methods A retrospective analysis of 32 patients with thyroid carcinoma younger than 18 years of age who underwent surgical treatment was performed. Results The 32 patients studied included 8 boys and 24 girls. The age at the onset of disease was less than 14 years in 11 patients and more than 14 years in 21 patients. Bilateral and unilateral thyroid lesions were found in 19 and 13 patients, respectively. While 23 patients had multiple lesions, 9 had single lesions. The tumor size was greater than 1 cm in 30 patients and less than 1 cm in 2 patients. Confirmed thyroid papillary and follicular thyroid carcinomas were diagnosed in 27 and 5 patients, respectively. Cervical lymph node metastasis occurred in 25 patients, and the transfer rate was 78.13%. Lymph node transfer in the Ⅰ-Ⅵ neck region and upper mediastinum occurred at rates of 3.13%, 31.25%, 31.25%, 37.50%, 9.38%, 68.75%, and 25.00%, respectively. While thyroid invasion was found in 12 patients, lung and lymph node metastases were seen in 5 and 10 patients, respectively. All patients received follow-up for 1-14 years, all survived except for one patient lost. Conclusion Differentiated thyroid carcinoma in children and adolescents is highly invasive with high metastatic and recurrence rates but low mortality. Total thyroidectomy and standard neck dissection, therefore, should be highly valued.