224例分化型甲状腺癌放射性碘治疗分析

Experience of 224 patients with differentiated thyroid carcinoma by radioiodine therapy

目的:对在我科8年来治疗的分化型甲状腺癌(DTC)患者进行回顾性分析,了解DTC发病规律,并证明131碘治疗DTC的疗效。方法:2002至2010年确诊为DTC并有颈部淋巴结转移的患者,进行甲状腺近全切除,并进行颈部淋巴结清扫,术后131碘治疗。131碘治疗后,每半年随访一次。随访指标:颈部超声检查;血清TSH、FT4、FT3;血清Tg、TgAb检查;全身放射性碘扫描;胸部CT或MRI。疗效判定:当血清Tg、TgAb阴性,颈部超声未见肿大淋巴结,全身放射性碘扫描未见放射性浓聚时,为DTC治愈。当上述指标为阳性时,则进行再次131碘治疗。用SPSS软件进行统计学处理。结果:DTC患者数逐年明显增加;乳头癌与滤泡癌的比例约为12(207):1(17),女性患者远多于男性,男:女患者患病比例约为1(57):3(167);DTC在20-55岁之间为高发年龄段,峰值在25-35岁之间;131碘治疗对DTC治愈率约达90%,近10%的顽固性DTC患者多次131碘治疗效果欠佳。结论:分化型甲状腺癌患病率有明显增加趋势,25-35岁为高发年龄,女性多于男性,早期诊断及早期治疗是关键。手术切除甲状腺后进行131碘治疗对DTC治愈率达90%。近10%的患者131碘治疗效果欠佳,需寻求更好的治疗方法。

Objective：To study the incidence of differentiated thyroid carcinoma（DTC） and the outcome of 131Iodine therapy for DTC,we summarized retrospectively data of patients with DTC who were managed by ^131Iodine therapy in our department in past 8 years.Methods：Patients with DTC and neck lymph nodes metastasis were diagnosed and near-total thyroidectomy were performed,and neck metastatic lymph nodes were excised.After operation they were treated by radioiodine.Patients were followed up once every half of year after 131Iodine therapy.To observe the following ited：neck ultrasound test,serum TSH,FT4,FT3 test,serum Tg,TgAb test,radioiodine whole body scan,chest CT or MRI.Assessment of outcome of ^131Iodine therapy ： when serum Tg,TgAb test was negative,without detectable metastatic lymph nods in neck ultrasound test,radioiodine whole body scan was negative,it was cure,otherwise ^131Iodine therapy was performed again.Result：DTC rates appear to be rising distinctly year after year,incidence of PDC was higher than that of FTC,the ratio of incidence was 12（207） ： 1（17）（PTC：FTC）,incidence of female was higher than male,the ratio was 3（167）：1（57）（female：male）.The incidence of DTC was higher in 20-55 year.Cured rate of ^131Iodine therapy for DTC was 90%.Conclusion：Thyroid cancer rate appear to be rising distinctly year after year.Incidence of DTC is most high in age of 25-35 yeas.Incidence of DTC in female patients is higher than males.Early diagnosis and therapy is most important.Cured rate of DTC is up to 90%,when using ^131Iodine therapy after operation consequent TSH suppression therapy.Repeat ^131Iodine therapy for near 10% of patients with persistent disease is unsatisfactory.