多次妊娠史甲状腺乳头状癌109例临床分析

Clinical analysis of 109 cases of papillary thyroid cancer with repeated gestation

目的探讨有多次妊娠史的甲状腺乳头状癌(PTC)患者的临床特点,以期对患者进行更有效的治疗,提高患者的预后。方法回顾性分析郑州大学第一附属医院2010年1月1日至2010年12月31日收治的有3次以上妊娠史的PTC住院患者(多次妊娠组)的临床资料以及6年的随访结果,并与同期有1次妊娠史的PTC患者(1次妊娠组)比较预后差异。结果 109例有多次妊娠史的PTC患者大部分就诊时无明显临床症状,彩超提示为多发结节71例(65.2%),且癌灶好发于右侧,86例(78.90%)患者病灶直径<2 cm。8例(7.34%)突破包膜,45例(42.28%)患者出现淋巴结转移,3例(2.75%)远处转移,共50例患者需要行131I治疗。多次妊娠组患者复发率较1次妊娠组高(P<0.05),两组生存率差异无统计学意义(P>0.05)。结论有多次妊娠史的PTC患者预后较差。对于有多次妊娠史患者,要尤为重视其治疗方法的选择与术后随访,对复发病灶及时做出处理。

Objective To investigate the clinical characteristics of papillary thyroid cancer（PTC） patients who had repeated gestation, in order to improve the prognosis and treatment of this disease. Methods The data and follow - up outcomes of PTC patients with repeated ges- tation （ repeated gestation group） in the First Affiliated Hospital of Zhengzhou University from January 1 of 2010 to December 31 of 2010 were retrospective analyzed. The PTC patients with one time of gestation （ one time of gestation group） in the same period were selected and the prognosis was compared. Results Most of the 109 patients with repeated gestation had no obvious clinical symptoms, and ultrasound showed multiple nodules in 71 cases （65.2%） and cancer more oceured in the right. About 86 （78.90%） cases of lesions size 〈 2 cm, 8 cases （7.34%） of breakthrough capsular of thyroid, 45 cases （42. 28% ） of lymph node metastasis, and 3 （2. 75% ） cases of distant metastasis. A total of 50 patients needed 131I treatment. Recurrence rate of repeated gestation group was higher than one time of gestation group （ P = 0. 032）, and there was no difference in the survival rate （P = 0. 058 ）. Conclusion PTC patients with repeated gestation have poor progno- sis. For PTC patients with a history of repeated gestation, the choice of treatment and postoperative follow - up should be emphasized. Recur- rent lesions should be dealt with timely treatment.