儿童分化型甲状腺癌综合治疗的探讨

The comprehensive treatment of differentiated thyroid carcinoma in children

目的探讨儿童甲状腺癌的临床特点及合理的综合治疗方法。方法回顾性分析了我院2000年1月～2008年1月收治的14岁以下37例分化型甲状腺癌的临床资料。1例甲状腺滤泡状癌仅行双侧甲状腺全切术；36例甲状腺乳头状癌行双侧甲状腺全切，根据肿块及淋巴结的情况行不同范围的颈淋巴结清扫术。手术后根据情况决定^131Ⅰ治疗及TSH抑制治疗的程度。结果术后并发症总的发生率为5．4％（2／37）。术后病理检查97．3％（36／37）为甲状腺乳头状癌，2．7％（1／37）为甲状腺滤泡状癌；多灶性癌的发生率为32．4％；淋巴结转移率为91．9％（34／37）。平均随访3．8年，无死亡病例，18．9％（7／37）出现颈淋巴结复发转移，8．1％（3／37）出现远处脏器转移。结论儿童甲状腺预后较好，治疗应采取双侧甲状腺全切加不同范围颈清扫的手术为中心，结合内分泌治疗和^131Ⅰ内照射治疗的综合治疗。

Objective To investigate the clinic characteristics and rational comprehensive treatment of differentiated thyroid carcinoma （DTC） in children. Methods The clinic data of 37 children under 14 years of age with DTC that admitted from January 2000 to January 2008 were analyzed retrospectively. Of them, total thyroidectomy was taken in one case of follicular thyroid carcinoma （FTC, 2.7%）, and total thyroidectomy combined with different range of neck lymph dissection that depended on the size of focus and the metastasis status during operation. , were taken in 36 cases with papillary thyroid carcinoma （PTC, 97. 3 %） The postoperative Radioiodine therapy and TSH suppressive therapy were applied selectively. Results Postoperative complications occurred in 2 cases （5.4%）, including hemorrhage and recurrent laryngeal nerve injury respectively. Twelve cases had multiple loci carcinoma （32. 4 %） and 34 cases （91.9%） associated with lymph node metastases. All patients were followed up with an average of 3. 8 years. The incidence of death, local recurrence and distant metastasis was 0%, 18. 9% and 8. 1% respectively. Conclusions The prognosis of thyroid carcinoma in children is favorable. The authors recommended that the comprehensive treatment should be included total thyroidectomy, different range of local lymph dissection combined with radioiodine therapy and TSH suppressive therapy.