腺叶切除不完全分化型甲状腺癌^(131)Ⅰ疗效观察

Efficacy of ^(131)I thyroid remnant ablation in patients with differentiated thyroid carcinoma after partial thyroidectomy

目的研究腺叶切除不完全的分化型甲状腺癌(DTC)患者实施放射性碘(^(131)I)清除甲状腺组织(清甲)治疗的效果。方法回顾性分析DTC术后接受^(131)I清甲治疗的103例患者的临床资料。根据甲状腺平面显像结果分为腺叶切除不完全组(n=33)和腺叶切除完全组(n=70)。首次^(131)I清甲剂量为1.11～3.7 GBq(30～100 mCi)。3～6个月后复查并评估清甲效果:若诊断剂量^(131)I全身显像显示颈部无放射性摄取即认为清甲完全;若有放射性摄取,即认为清甲不完全,需再次行^(131)I清甲治疗,定期随访复查清甲效果。结果实施3次清甲治疗的成功率,腺叶切除完全组分别为61.43%、88.89%和100%,腺叶切除不完全组分别为21.21%、46.15%和78.57%。统计学分析表明,腺叶切除完全组的第1、2次清甲疗效与腺叶切除不完全组的第2、3次清甲疗效比较,差异均无统计学意义(P>0.05)。结论对于甲状腺腺叶切除不完全的DTC患者,实施^(131)I治疗的一次清甲成功率较低,但经2～3次治疗后同样可达到较高的清甲疗效。尤其适用于再次手术可能会导致严重的手术并发症或拒绝再次手术的患者。

Objective To observe the efficacy of radioactive iodine （^131 I） thyroid remnant ablation in patients with differentiated thyroid carcinoma （DTC） after partial thyroidectomy. Methods The clinical data of 103 patients with ^131I thyroid remnant ablation after DTC were retrospectively analysed. Patients were divided into partial thyroideetomy group （n = 33）and complete thyroidectomy group （n = 70）according to the findings of thyroid planar imaging. The first ablation dose was 1.11 -3.7 GBq （30 - 100 mCi）. Diagnostic ^131I whole body scan was used to evaluate the efficacy of ablation 3 to 6 months later. If no visible radioactive uptake in thyroid bed was found, the ablation was defined to be complete. Otherwise, the ablation was defined to be partial, and patients needed a second or third dose of ^131I with routine follow-up. Results After the first, second and third ablation, the rates of complete ablation in complete thyroidectomy group were 61.43%, 88.89% and 100%, and those in partial thyroidectomy group were 21.21%, 46.15% and 78.57%. There was no significant difference between the efficacy of the first and second ablation in complete thyroidectomy group and that of the second and third ablation in partial thyroidectomy group （ P 〉 0.05）. Conclusion The efficacy of ^131 I thyroid remnant ablation in patients with DTC after partial thyroidectomy may not be favourable at the first dose, while a high rate of complete ablation can be achieved at the second or third dose.