儿童和青少年甲状腺癌的治疗及结果评价

Treatment and outcome evaluation for thyroid cancer in children

目的探讨儿童和青少年分化良好的甲状腺癌高复发率及总生存率间的关系。方法收集1985～2005年间在汕头大学附属第一医院治疗的分化良好的甲状腺癌患者病历75份,用以回顾分析疾病进程、治疗和结果。结果颈部转移阳性60例（80%）,均累及中央室淋巴结,出现侧颈部结节性转移36例,远端转移4例。进行甲状腺全切除术并辅以放射性碘治疗67例,进行偏侧甲状腺切除术8例;所有病例均辅以颈部治疗。颈淋巴清扫的术式并不影响复发或远端转移的出现。所有死亡病例（2例）归因于远端转移。结论青少年患者中,分化良好甲状腺癌的最佳治疗选择为甲状腺全切除术,局部疾病或复发均不影响存活率。

Objective To investigate the relationship between high recurrence rate in well-differentiated thyroid cancer in children and the total survival rate by analyzing patients＇ manifestation at late stage.Methods The data of 75 patients with well-differentiated thyroid cancer treated were retrospectively analyzed. Results Sixty patients （80%） had neck metastases with involvement of central compartment lymph nodes, and lateral neck nodes metastases in 36 cases, and distant metastases in 4 cases. Sixty-seven patients underwent total thyroidectomy with adjuvant radioiodine treatment and 8 patients underwent hemithyroidectomy; all the patients received concomitant neck treatment. The recurrence rate in local region （5%） and neck （9%）, which was similar to the total recurrence rate reported in adults. Type of neck dissection did not affect recurrence or appearance of distant metastases. All deaths （ n = 2 ） were due to distant metastases, whereas 30% of adult deaths were due to local or neck diseases. Conclusion The best way to treat well differentiated thyroid cancer is total thyroideetomy. Neither regional diseases nor recurrences affect survival rate.