大剂量^(131)Ⅰ对分化型甲状腺癌患者术后剩余甲状腺组织的去除治疗

High Dose ^(131)Ⅰ for Remnant Thyroid Tissue Ablation in Patients with Differentiated Thyroid Carcinoma Postoperation

[目的]探讨131Ⅰ对分化型甲状腺癌患者术后剩余甲状腺组织的去除治疗剂量及去除治疗效果。[方法]分化型甲状腺癌患者55例,根据131Ⅰ全身显像及99mTcO4-甲状腺扫描的情况,具有一叶或一叶以上的残留甲状腺组织,给予3.7GBq～4.44GBq;具有一叶以下的残留甲状腺组织,给予2.96GBq～3.7GBq;伴有甲状腺外转移(如肺、骨、颈部淋巴结等)则常规给予3.7GBq后3个月,再行大剂量131Ⅰ治疗转移灶。[结果]大部分患者1次大剂量131Ⅰ就可以达到去除治疗的效果。对于一叶或一叶以上的剩余甲状腺较多的或者伴有甲状腺外转移的患者,则1次131Ⅰ去除治疗的效果稍差,需接受第2次去除治疗。采用131I2.96GBq～3.7GBq平均剂量为3.7GBq作为去除剂量,完全去除率为85.5%。[结论]剩余甲状腺量、有无甲状腺外的转移、剩余甲状腺吸131Ⅰ率是影响去除治疗效果的重要因素。131Ⅰ去除治疗后定期监测血HTG变化是判断DTC患者有无复发或转移及评价131I治疗效果的重要指标。

[Purpose ] To explore the dose and effect of ^131Ⅰ ablation for the remnant thyroid tissue ablation in patients with differentiated thyroid carcinoma postoperation. [Methods] Fifty-five cases with differentiated thyroid carcinoma with remnant thyroid tissue postoperation detected by ^131Ⅰ whole-body scan and ^99mTcO4^- thyroid scan. Those remnant underwent ^131Ⅰ 3.7GBq to 4.44GBq, those remnant less than 1 lole 2.96GBq to 3.7GBq, and those with metastasis beyond thyroid （such as lung, bone, cervical lymph node, etc） generally underwent 3.7 GBq and the metastatic lesions were treated with high dose ^131Ⅰ after three months. [Results ] Most of patients could achieved the ablated effect with high dose ^131Ⅰ only for one time. The effect of ablation was worse in the patients with remnant thyroid tissue more than 1 lose or with metastasis beyond thyroid, they needed the second remnant ablation. The ablated effect was 85.5 percent with ^131Ⅰdose of 2.96GBq to 3.7GBq, 3.7GBq in average. [Conclusion] The volume of remnant thyroid, metastasis beyond thyroid, and rate of remnant thyroid radioiodine uptaken are the important influent factors on the ablation effect. Regularly checking the HTG after radioiodine ablation is an important index for recurrence or metastasis and for evaluating the effect of ^131Ⅰ ablation.