儿童甲状腺癌62例临床分析

Clinical analysis of thyroid cancer in 62 children

目的分析甲状腺癌临床特点和预后情况。方法对2006年7月至2017年12月于首都医科大学附属北京儿童医院内分泌遗传代谢科、耳鼻咽喉头颈外科及肿瘤外科住院接受治疗的164例中位年龄9岁3月龄（出生-16岁1月龄）甲状腺占位性疾病患儿（男孩60例，女孩104例）进行病历资料收集，对其中62例甲状腺癌患儿的临床资料进行回顾性分析及预后随访。结果2006年7月至2017年12月甲状腺癌占住院登记的甲状腺占位性疾病的37．8％（62／164）。甲状腺占位性疾病患儿每2年登记例数依次为13、21、19、33、38、41，其中甲状腺癌每2年诊断例数依次为2、5、3、8、21、23。62例甲状腺癌患儿中1例为滤泡状癌，余均为乳头状癌。60例以发现颈部肿物就诊，2例以呼吸道压迫症状为主诉就诊。62例甲状腺癌患儿均接受相应的甲状腺癌手术治疗。甲状腺癌术后电话随访到患儿48例，随访时间0．25-8．67年，随访2年以上的病例〉50％，多数预后良好。98％患儿远期甲状腺功能减低，甲状腺素替代治疗满意；33％患儿有低钙血症，仅5例低钙血症患儿自然缓解，平均缓解时间1．9个月，最晚6个月缓解，其余按照继发甲状旁腺功能减退治疗，无明显低钙血症。9例术后有远处转移。6例复发，平均复发时间为12．8个月，最晚2年。最长追访8年，无死亡病例。结论12年来儿童甲状腺占位性疾病及甲状腺癌发病率呈上升趋势。儿童甲状腺癌术后远期并发症以甲状腺功能减低、低钙血症为主，低钙血症6个月之内可有自然缓解，总体治疗效果满意，无死亡病例。

Objective To analyze the clinical characteristics and prognosis of thyroid cancer in children.Methods Clinical data of 164 children （60 boys,104 girls） with space-occupying lesions of the thyroid who were hospitalized in Beijing Children＇s Hospital Affiliated to Capital Medical University from July 2006 to December 2017 were collected.Sixty-two children with thyroid cancer were reviewed respectively and followed up by telephone.Results From July 2006 to December 2017,children with thyroid cancer accounted for 37.8% （62/164） of children with space-occupying lesions of the thyroid.The number of children with space-occupying lesions of the thyroid every 2 years was 13,21,19,33,38,41,and the number of children with thyroid cancer every 2 years was 2,5,3,8,21,23.One out of 62 thyroid cancer was follicular thyroid cancer,the others were papillary thyroid cancer,neck mass was the chief complaint in 60 of 62 patients.Two cases were brought to hospital with respiratory tract oppression as the chief complaint.Forty-eight cases got long-term follow-up by telephone,over 50 percent of cases received follow-up for more than 2 years,the median follow-up time was 2.63 years （0.25-8.67 years）,most of these patients had favorable prognoses.Hypothyroidism （98%） and hypocalcemia （33%） were main long-term complication.Hypothyroidism recovered well after thyroxine replacement therapy,and in only 5 children hypocalcemia was spontaneously relieved,the average remission time was 1.9 months,the longest time for recovering from hypocalcemia was 6 months;the other cases responded well when they were treated as secondary hypoparathyroidism,with no hypocalcemia symptoms.Nine children had distant metastasis after operation,the average recurrence time was 12.8 months,and the latest relapsing time was 2 years.The overall prognosis was good,the longest follow-up period was 8 years and no death was found.Conclusions Pediatric space-occupying lesions of the thyroid and thyroid cancer are rising during the last 12 years.Hypothyroidism and hypocalcemia are main long-term complications after surgery,the children cases recovered well,the remission of hypocalcemia was achieved not later than 6 months.The overall prognosis of childhood thyroid cancer was good,without death within the follow-up period.