^131I首次清除分化型甲状腺癌残留组织的影响因素探讨

The effect factors of first iodine- 131 ablation of thyroid remnants in patients with differentiated thyroid cancer

目的观察^131I首次“清甲”的疗效及分析其影响因素。方法确诊分化型甲状腺癌（DTC）患者经手术治疗后行^131I治疗，然后按手术方式、术后治疗时间^131I的剂量进行分类，观察首次“清甲”的疗效。结果“清甲”成功率：甲状腺全切88．5％，次全切除44．4％；“清甲”时间术后1～2个月92．7％，1年以上50．0％；^131I剂量2．96GBq为47．6％，4．44GBq为82．8％。结论DTC治疗应以甲状腺全切及颈淋巴结清扫为首选治疗方式，术后1～2个月为^131I“清甲”最佳时机，首次“清甲”^131I剂量以4．44GBq（120mci）为宜。

Objective To observe the effect of the first iodine - 131 ablation of thyroid remnants in patients with differentiated thyroid cancer （DTC） and discuss factors that may be influential in the treatment. Methods All DTC patients confirmed by pathology received iodine - 131 therapy after necessary preparation. According different operation procedures, time interval between operation and iodine - 131 treatment and dose of iodine - 131, the patients were divided into different groups. Therapy effects were observed in different groups. Results Ablation successful rate was 88.5% in total thyroidectomy group, compared with 44.4% in subtotal tbyroidectomy group. 92.7% ablation rate was seen in the group of 1 -2 months time interval between operation and iodine - 131 treatment, while in the group of over 1 year time interval, only 50% ablationrate was achieved. Ablation successful rate was 47.6% in the group of low dose of iodine - 131 （ 2.96GBq）, compared with 82.8% in the high dose group （4.44GBq）. Conclusions Total thyroidectomy and cervical lymph nodes dissection should be recommended for the patients with DTC. The better interval time between operation and iodine - 131 ablation thyroid remnants is 1 -2 months. The high dose of iodine - 131 shows better result than low dose of iodine - 131 treatment.