青少年分化型甲状腺癌60例临床分析

Clinical analysis of 60 cases with differentiaed thyroid carcinoma of adolescents

目的:讨论青少年分化型甲状腺癌的临床表现、诊断、最佳治疗方法及预后。方法:回顾性分析1995-2010年间收治的20岁以下青少年分化型甲状腺癌60例,均为散发病例。结果:全组均行手术辅以内分泌治疗。60例青少年甲状腺癌中乳头状腺癌51例,滤泡状癌9例。伴颈淋巴结转移者17例,其中双侧甲状腺癌并双颈淋巴结转移2例,占3.3%。手术方式包括甲状腺患侧腺叶加峡部切除45例(其中行患侧功能性颈清扫8例);患侧腺叶加峡部切除及对侧大部切除13例(其中行单侧颈清扫5例,双侧颈清扫2例);甲状腺全切术加双侧颈清扫术2例。术后均予甲状腺素内分泌抑制治疗。随访时间2-17年,其中25例获得10年以上随访。5年及10年生存率均为100%。结论:青少年分化型甲状腺癌多为乳头状癌,预后较好,彩超为首选诊断检查,细针穿刺细胞学确诊率高,治疗关键在于首次手术方式的合理选择。

Objective：To study the clinical characteristics,diagnosis,treatment and prognosis of adolescent thyroid carcinoma. Methods：The records of 60 cases of adolescent thyroid carcinoma under 20 years old between 1995 and 2010 were reviewed. All the cases were sporadic. Results：All patients underwent surgical treatment and hormone sup-pressive therapy. The pathological test revealed papillary carcinoma 51 cases,follicular carcinoma 9 cases. Cervical lymphonode metastasis was found in 1 7 cases ,2 cases of them with bilateral cervical lymph node metastasis ,were 3. 3% in all the cases. Treatment consisted of lobectomy in 45 cases（8 cases received neck dissection）,subtotal thy-roidectomy in 13 cases（ unilateral dissection in 5 and bilateral dissection in 2 cases）,total thyroidectomy and bilater-al dissection in 2 cases. All the cases received postoperative thyroid hormone suppressive therapy. The follow-up pe-riod was 2 to 17 years（ with 25 cases over 10 years）. The 5- and 10-year survival rates were 100%. Conclusion：Differentiaed thyroid carcinoma of adolescents has a good prognosis and color ultrasound is the primary examination method,fine needle aspiration is available for diagnosis. The first reasonable operational manner is the most important.