甲状腺全切术结合131Ⅰ清甲治疗甲状腺嗜酸细胞肿瘤的效果观察

Observation on effect of total thyroidectomy combined with 131Ⅰ thyroid remnant ablation for the treatment of Hurthle cell tumor

目的观察甲状腺全切术结合131Ⅰ清甲治疗甲状腺嗜酸细胞肿瘤(HCT)的效果。方法 60例甲状腺嗜酸细胞肿瘤患者,根据治疗方法不同分为观察组与对照组,每组30例。对照组采用单纯甲状腺全切术治疗,观察组在对照组基础上采用131Ⅰ清甲治疗。观察并比较两组患者术后并发症(手足麻木感、甲状腺功能减退、喉返神经损伤)发生情况、甲状旁腺激素(PTH)水平及治疗效果;随访1年,比较两组患者肿瘤复发情况。结果对照组术后并发症发生率为13.33%,观察组术后并发症发生率为16.67%;两组患者并发症发生率比较,差异无统计学意义(P>0.05)。观察组患者中术后1个月经131Ⅰ清甲治疗成功者11例;其余19例患者中,接受第2阶段的131Ⅰ清甲治疗者12例,接受第3阶段的131Ⅰ清甲治疗者7例,接受第4阶段的131Ⅰ清甲治疗者6例。观察组中接受第1、2、3、4阶段治疗的患者治疗前PTH水平分别为(12.95±1.24)、(13.54±1.01)、(13.87±1.11)、(14.12±1.15)ng/dl,与对照组的(12.89±1.33)、(13.45±1.08)、(13.79±1.14)、(14.17±1.20)ng/dl比较,差异均无统计学意义(P>0.05)。观察组治疗总有效率90.00%高于对照组的66.67%,肿瘤复发率3.33%低于对照组的20.00%,差异均具有统计学意义(P<0.05)。结论甲状腺全切术配合术后131Ⅰ清甲用于甲状腺嗜酸细胞肿瘤治疗中疗效确切,对甲状旁腺功能影响小,且利于预防肿瘤复发,值得推广。

Objective To observe the effect of total thyroidectomy combined with 131Ⅰ thyroid remnant ablation for the treatment of Hurthle cell tumor(HCT). Methods A total of 60 Hurthle cell tumor patients were divided by different treatment methods into observation group and control group, with 30 cases in each group. The control group received total thyroidectomy, and the observation group received 131Ⅰ thyroid remnant ablation on the basis of the control group. Observation and comparison were made on incidence of postoperative complications(numbness of hands and feet, hypothyroidism, injury of recurrent laryngeal nerve), parathyroid hormone(PTH)and the treatment effect and recurrence of tumor after 1 year of follow-up between the two groups. Results The control group had incidence of postoperative complications as 13.33%, and the observation group had incidence of postoperative complications as 16.67%. There was no significant difference in the incidence of complications between the two groups(P>0.05). In observation group, 11 patients were successfully treated with 131Ⅰ thyroid remnant ablation 1 month after operation;among the remaining 19 patients, 12 patients received the second phase of 131Ⅰ thyroid remnant ablation, 7 patients received the third phase of 131Ⅰ thyroid remnant ablation, and6 patients received the fourth stage of 131Ⅰ thyroid remnant ablation. Patients in the observation group who receiving1, 2, 3, and 4 phase of treatments had PTH levels before treatment respectively as(12.95±1.24),(13.54±1.01),(13.87±1.11) and(14.12±1.15) ng/dl, and there was no statistically significant difference, compared with(12.89±1.33),(13.45±1.08),(13.79±1.14) and(14.17±1.20) ng/dl in the control group of the same period(P>0.05). The observation group had higher total treatment effective rate as 90.00% than 66.67% in the control group, and lower recurrence rate of tumor as 3.33% than 20.00% in the control group. Their difference was statistically significant(P<0.05). Conclusion Total thyroidectomy combined with 131Ⅰ thyroid remnant ablation shows affirmative efficacy for the treatment of Hurthle cell tumor. It has little effect on parathyroid function and is conducive to the prevention of recurrence of tumors. It is worth promoting.