100例分化型甲状腺癌术后131I治疗的疗效及安全性评价

目的：探讨131I在分化型甲状腺癌（differentiated thyroid cancer，DTC）术后清除残留甲状腺组织（清甲）和转移灶（清灶）治疗中的疗效及安全性。方法随机选取100例进行131I清甲及清灶治疗的DTC患者。所有患者治疗前3～4周均停服L-T4，并予以131I（2.96～5.55）×103 MBq清甲治疗；治疗后口服L-T4替代治疗，6个月后复查，根据颈部超声、全身显像及血清甲状腺球蛋白（thyroglobulin，Tg）水平评价131I治疗的效果。结果所有的患者均接受1～3次的131I治疗，共140个疗程，平均每次治疗剂量为4.03×103 MBq，1次131I治疗成功率为67%，2次131I治疗成功率为92%，经131I治疗后患者的Tg转阴率为53.3％；治疗后5例患者出现一过性白细胞下降，治疗前后肝肾功能无明显改变。结论 DTC患者术后尽早进行规范化的131I治疗，具有治疗次数少、清甲成功率高且不良反应少的特点，对预防甲状腺癌的复发有重要的作用。

Evaluation of efficacy and safety of 131I postoperative treatment in 100 case of differentiated thyroid cancer

Objective To study the efficacy and safety of 131I in ablation of thyroid remnant and metastatic lesions of differentiated thyroid carcinoma (DTC). Method One hundred DTC patients received postoperative ablation of thyroid remnant and metastatic lesions in our hospital from April 2012 to December 2013 were enrolled. All patients were asked to stop taking L-T4 3-4 weeks before the treatment, and then had ablation with 131I at (2.96-5.55) × 103 MBq. Oral L-T4 administration was followed as alternative therapy. All patients were reevaluated after 6 months, and the efficacy was assessed based on neck ultrasonography, whole-body radioiodine scan and serum Tg testing. Result Patients in this cohort received 1-3 times of 131I treatment, adding up to 140 treatment courses given totally. The aver-age dose of each treatment was 4.03×103 MBq, with response rate of 67% and 92% for single and double treatment, respectively. 53.3% patients had negative Tg after treatment, and 5 patients experienced transient leucopenia, while no obvious changes were observed in liver and renal functions after treatment. Conclusion Early application of stan-dard 131I is recommended for DTC patients, few administrations would provide promising response rates, with minor adverse reactions, thus it is effective against recurrence of thyroid cancer.