儿童和青少年甲状腺癌的治疗及结果评价.docVIP

儿童和青少年甲状腺癌的治疗及结果评价 　　作者：陈坤壮 孙淑明 马涛 作者单位：516538 广东省陆丰市甲子人民医院外科(陈坤壮);汕头大学医学院第一附属医院普外科(孙淑明、马涛) 　　【摘要】 目的 探讨儿童和青少年分化良好的甲状腺癌高复发率及总生存率间的关系。方法 收集1985～2005年间在汕头大学附属第一医院治疗的分化良好的甲状腺癌患者病历75份，用以回顾分析疾病进程、治疗和结果。结果 颈部转移阳性60例(80%)，均累及中央室淋巴结，出现侧颈部结节性转移36例，远端转移4例。进行甲状腺全切除术并辅以放射性碘治疗67例，进行偏侧甲状腺切除术8例;所有病例均辅以颈部治疗。颈淋巴清扫的术式并不影响复发或远端转移的出现。所有死亡病例(2例)归因于远端转移。结论 青少年患者中，分化良好甲状腺癌的最佳治疗选择为甲状腺全切除术，局部疾病或复发均不影响存活率。 　　【关键词】 甲状腺癌;淋巴结清扫;儿童 　　Treatment and outcome evaluation for thyroid cancer in children CHEN Kunzhuang*, SUN Shuming, MA Tao.*Department of Surgery, Jiazi Peoples Hospital of Lufeng City, Guangdong, Lufeng 516538 　　【Abstract】 Objective To investigate the relationship between high recurrence rate in welldifferentiated thyroid cancer in children and the total survival rate by analyzing patients manifestation at late stage.Methods The data of 75 patients with welldifferentiated thyroid cancer treated were retrospectively analyzed.Results Sixty patients (80%) had neck metastases with involvement of central compartment lymph nodes, and lateral neck nodes metastases in 36 cases, and distant metastases in 4 cases. Sixtyseven patients underwent total thyroidectomy with adjuvant radioiodine treatment and 8 patients underwent hemithyroidectomy; all the patients received concomitant neck treatment. The recurrence rate in local region (5%) and neck (9%), which was similar to the total recurrence rate reported in adults.Type of neck dissection did not affect recurrence or appearance of distant metastases. All deaths (n=2) were due to distant metastases, whereas 30% of adult deaths were due to local or neck diseases.Conclusion The best way to treat well differentiated thyroid cancer is total thyroidectomy. Neither regional diseases nor recurrences affect survival rate. 　　【Key words】 thyroid cancer; neck dissection; children 　　分化良好的甲状腺癌在儿童和青少年较少见，临床病例的发生率很低[1]。近90%的甲状腺癌患儿伴发局部淋巴结转移，10%～20%伴发远距器质性疾病[2，3]。晚期局限性和局部复发也很常见，但与其他肿瘤不同的是癌复发并不影响存活率[4]。该肿瘤侵袭性临床行为和良性预后间的矛盾存在争论。关于一般人群的治疗范围，