分化型甲状腺癌术后^(131)I治疗对复发的影响  

The impact of ^(131)I therapy on the recurrence of differentiated thyroid carcinoma after thyroidectomy

作　　者：余永利[1] 罗全勇[1] 陈立波[1] 陆汉魁[1] 朱瑞森[1] 马寄晓[1] 

机构地区：[1]上海交通大学附属第六人民医院核医学科,200233

出　　处：《中华核医学杂志》2004年第4期217-219,共3页Chinese Journal of Nuclear Medicine

基　　金：上海市科技发展基金资助项目 (0 2 4 1 1 90 53)

摘　　要：目的　探讨分化型甲状腺癌 (DTC)术后复发的影响因素。方法　DTC术后随访患者 3组 :1组 2 98例 ,均为术后复发患者 ,分析首诊年龄、性别、术式、病理类型等因素对复发的影响 ;2组10 8例 ,为术后行甲状腺素替代治疗的患者 ;3组 12 4例 ,为术后行甲状腺素替代 +1 31 I清除甲状腺剩余组织治疗的患者。进行后两组间年复发率对照分析。结果　① 1组DTC复发患者性别男、女之比(1∶1 5 )和病理类型滤泡状、乳头状癌之比 (1∶4 )均高于文献 (1∶2～ 3和 1∶8) ;原发灶甲状腺癌肿块切除、甲状腺单侧腺叶切除和双侧腺叶切除者复发百分率依次降低 (分别为 4 7 3%、34 2 %和 18 5 % ) ;复发多出现于术后 5年内 (6 5 1% ) ;复发部位以颈淋巴结居多 (2 3 5 % )。② 2组DTC术后 1、5和 10年复发率分别为 4 6 3%、8 33%和 12 0 4 % ,5 3 85 % (7 13例 )发生在术后 2年内 ,近端和远端复发分别占 5 3 84 %和 30 77% ;3组 1、5、10年复发率分别为 0 81%、4 0 3%和 7 2 6 % ,5 9例发生在术后 4年内 ,近端和远端复发分别为 5 9例和 2 9例。两组间差异有显著性 (P <0 0 5 )。结论　DTC首诊年龄、性别、术式、病理类型等对术后复发有一定影响 ;DTC术后行甲状腺素替代 +1 31 I清除甲状腺剩余组织治疗可改善DTC预后Objective To investigate the effects of some factors on recurrence after thyroidectomy of differentiated thyroid carcinoma (DTC). Methods Three groups of DTC cases were studied during follow-up. All cases (n=298) of group 1 with diagnosed recurrence were analyzed statistically on age,gender,thyroid-operating mode and pathologic nature at first diagnosis. One hundred and eight cases of group 2 had received thyroid hormone-replaced therapy and 124 cases of group 3 had received thyroid hormone-replaced plus 131 I ablating therapy after thyroidectomy,and were analyzed and compared statistically by their therapeutic outcomes. Results ①From group 1,the ratios of male/female (1∶1.5) and follicular/papillary (1∶4) were higher than primary cases reported in literatures (1∶2～3 and 1∶8). The recurrence rates in the cases had primary lesion excised,unilateral thyroid or bilateral thyroid excised were decreased 47.3%,34.2% and 18.5%,respectively. Recurrence mainly occurred at first 5 years after thyroidectomy (65.1%). ②From group 2,recurrence rates were 4.63%,8.33% and 12.04%,respectively at 1,5 and 10 years,and 53.84% and 30.77%,respectively as local recurrence and distant metastases. From group 3,recurrence rates were 0.81%,4.03% and 7.26%,respectively in 1,5 and 10 years,and 5/9 and 2/9 as local recurrence and distant metastases,respectively. The statistic difference was significant (P<0.05) between group 2 and group 3. Conclusions The patients' age,gender,thyroid-operating mode and pathologic nature of DTC at first diagnosis may have some effects on recurrence. Thyroid hormone-replaced plus 131 I ablating therapy after thyroidectomy may improve the prognosis of DTC (prolonging recurrence-free time,reducing recurrence rate and decreasing distant metastases).

关 键 词：复发率 术后复发 患者 治疗 分化型甲状腺癌 甲状腺素 病理类型 结论 文献 百分率 

分 类 号：R736.1[医药卫生—肿瘤] R735[医药卫生—临床医学]