-%27131-Ⅰ治疗甲状腺癌转移的疗效和影响因素分析.pdfVIP

131 131 2 I 治疗以前发现的淋巴结转移灶较 I 治疗过程中发现者消除率高，X = 13.481，P = 0.00＜0.05，差异有统计学意义。有淋巴结转移灶切除 史的患者消除率高于无淋巴结转移灶切除史的患者，X2 = 14.628，P = 0.00＜0.05，差异有统计学意义。对于肺转移的治疗，胸部X 线平片分 别表现为阴性、两肺粟粒状或细小结节影、团块状影或两肺多发结节影 的3 组患者，肺部转移灶的消除率依次下降。对于骨转移的治疗，本组 中仅1 例消除，消除率为7.7%。 131I 内放射是一种有效的方法。年龄 结论：对于DTC 转移灶的治疗， 和转移部位是 131I 治疗总体疗效的影响因素。而性别、病理类型、甲状 腺切除距首次 131I 治疗的时间3 项指标与治愈率的关系不大。对于淋巴 结转移的治疗，淋巴结转移灶发现的时间和淋巴结转移灶切除史是消除 淋巴结转移灶的影响因素。其中，后者起着重要的作用，应尽可能先行 手术治疗。对于肺转移的治疗，胸部X 线平片表现可能是消除肺部转移 灶的影响因素。肺部转移灶不摄取 131I 的患者，应尽早寻找其它方法。 对于骨转移的治疗，可以减轻患者症状，提高生活质量，但总体疗效较 差。推荐有摄取 131I 功能的、可切除的骨转移灶先行手术治疗。总之， 转移灶一旦明确，无论位于何处都应该早期治疗，以利于患者生存率的 提高。 关键词：分化型甲状腺癌，碘放射性同位素，放射疗法，疗效评价，影 响因素 THERAPEUTIC EFFECT AND ANALYSIS OF INFLUENCE FACTORS ON 131I TREATMENT OF METASTATIC THYROID CARCINOMA ABSTRACT Objective: The thyroid carcinoma is the most common malignant endocrine tumor，which takes up 1% in all human tumors. Although the differentiated thyroid carcinoma (DTC) usually shows low malignancy, develops slowly and has a well prognosis，the survival rate would decline obviously if metastases，especially the distant metastases happen. Besides the surgery, 131I therapy is the major treatment to the metastases in DTC. The object of this retrospective study is to investigate the therapeutic effect and analyze the influence factors on 131I treatment of metastatic DTC. Methods: Collecting clinical data of 97 DTC patients with metastases at the Department of nuclear medicine, Xinhua Hospital from Jan 1996 to Jan 2006. A retrospective study is analyzed by Student-test, Chi-square test and Fisher’s exact test. Result: Of all 97 DTC with metastases patients treated by 131I therapy, 44 patients (45.4％) were completely cured, 41 patients were improved or controlled and the overall effective rate reached 87.6%. The co