~(131)I治疗甲状腺癌498例临床分析

目的探讨治疗分化型甲状腺癌的疗效。方法采用回顾性分析方法,将行甲状腺次全切除术或全切术并经病理确诊为甲状腺乳头状癌或滤泡状癌患者498例,于131I治疗前1个月禁食含碘食物、药物、优甲乐,使血清中TSH≥30 mU/L。采用131I一次口服,"清甲"、淋巴结转移、远处脏器转移剂量分别为3.7、5.55、7.4 GBq。131I治疗后7 d,行全身ECT扫描,若患者体内有核素浓集,4个月后再次服131I。结果 31～50岁发病人数占63.5%。行次全切、次全切+单侧颈廓清、全切、全切+单侧颈廓清、全切+双颈廓清术分别为85、62、251、72、28例。行1、2、3次手术者分别为451、39、8例。有、无颈部淋巴结转移者分别为419、79例。甲状腺内有一个癌结节者130例,一叶内有2个癌结节者59例,左右叶内各有1个及以上癌结节者309例。癌结节有、无局部侵犯者分别为139、359例。乳头状、滤泡状、乳头+滤泡状癌分别为464、25、9例。Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为61、155、268、14例。有远处转移患者共14例。274例患者2次服131I后、130例患者3次服131I后、58例患者4次服131I后、20例患者5次服131I后、5例患者6次服131I后ECT扫描证实全身无核素浓集,其中3例肺转移患者6次服131I后ECT扫描证实全身无核素浓集,11例骨转移或肺转移患者服131I后ECT扫描证实仍有核素浓集。结论131I是分化型甲状腺癌术后治疗的有效方法。甲状腺残留多、有局部侵犯的患者,会增加服131I的次数。有远处转移的甲状腺癌患者仍有治愈可能,但是有肺、骨等远处转移的患者仍是治疗的难点。

Clinical analysis on 131I therapy in 498 cases of thyroid carcinoma

Objective To analyze the efficacy of radioiodine(131I) for differentiated thyroid carcinoma(DTC).Methods A total of 498 patients pathologically diagnosed as thyroid papillary carcinoma or follicular carcinoma,who had undergone subtotal or total thyroidectomy,were retrospectively analyzed.Food and drugs containing iodine,as well as L-Thyroxine,could not be taken in for 1 month before 131I therapy to ensure the serum concentration of TSH not less than 30 mU/L.The dose of 131I were 3.7,5.55 and 7.4 GBq respectively for patients after thyroid remnant ablation or with lymph node metastasis and distant organ metastasis,and the dose should be taken orally for one time.ECT scanning all over the body would be given after 7 days.If nuclide concentration in vivo was found,the therapy would be given again 4 months later.Results Incidence of age group from 31 to 50 years in all the cases accounted for 63.5%.The cases undergoing surgery of subtotal thyroidectomy,subtotal thyroidectomy plus unilateral cervical lymph node dissection,total thyroidectomy,and total thyroidectomy plus bilateral cervical lymph node dissection were 85,62,251,72 and 28,respectively.There were 451,39 and 8 cases that received surgery for one or two or three times.The cases undergoing surgery with or without cervical lymph node metastasis were 419 and 79.The cases with single cancer nodules in thyroid gland were 130,two nodules in one lobe 59,and one and more nodules in each lobe(left and right) 309.The cases with or without cancer nodules local invasion were 139 and 359,respectively.Pathologically,papillary,follicular,and papillary-follicular carcinoma cases were 464,25 and 9,respectively.The numbers of patients in Ⅰ,Ⅱ,Ⅲ and Ⅳ stage were 61,155,268 and 14,respectively.There were 14 cases with distant metastasis.ECT scanning confirmed no nuclide concentration all over the body in 274 cases after 131I therapy was given for two times,in 130 cases after for three times,in 58 cases after for four times,in 20 cases after for five times and in 5 cases after for six times.As for metastasis,3 cases with lung metastasis and 11 cases with bone metastasis or lung metastasis were confirmed nuclide concentration in body.Conclusion It is suggested that 131I therapy is an effective method to differentiated thyroid carcinoma after surgery.The patients will be given more times of the therapy if they have much thyroid residue or local malignant cell invasion.There is still possibility to heal thyroid carcinoma with distant metastases,except lung or bone metastases.