放射性 ^(131)碘治疗术后小病灶乳头状甲状腺癌临床研究  

Clinical study of ^(131)I treatment after thyroidectomy of small focal papillary thyroid carcinoma

作　　者：赵志刚[1] 彭亮[1] 李亚军[1] 吴晓杰[1] 廉英[1] 孟丹[1] 谢路林[1] 王晶[1] 张晓平[1] 聂江[1] 庄岚[1] 

机构地区：[1]解放军第210医院核医学科,辽宁大连116015

出　　处：《临床军医杂志》2013年第7期716-718,共3页Clinical Journal of Medical Officers

摘　　要：目的探讨一叶甲状腺有单个较小癌结节的患者术后有无进行131I清甲的必要性。方法采用回顾性分析方法,将行甲状腺次全切除术或全切除术后经病理确诊为乳头状甲状腺癌患者105例,按结节大小分为≤1 cm、>1 cm~≤2 cm、>2 cm~≤3 cm组,各组再按未服或服用放射性131I分为两组,比较两组的年龄、性别比、甲状腺癌结节部位、手术方式、术后随访时间及复发例数。服用131I者,按要求进行清甲是否完全的评估,直到清甲成功。结果 >2 cm~≤3 cm组未服131I者与服用131I者各项指标比较,差异均无统计学意义(P>0.05),≤1 cm组未服131I者甲状腺癌结节位于左叶者明显多于服131I者(P<0.01)。>1 cm~≤2 cm组未服131I者甲状腺全切除术式明显少于服131I者(P<0.01)。三组中未服131I者中位随访时间73个月,服用131I组者中位随访时间32个月,≤1 cm组及>1 cm~≤2 cm组患者均未见复发,>2 cm~≤3 cm组未服131I者复发3例(18.8%),服用131I者未见复发,两者比较,差异无统计学意义(P>0.05)。32例患者服1次131I即清甲成功,12例患者服2次131I清甲成功,1次清甲成功率72.8%。结论一侧甲状腺有单个较小癌结节(≤2 cm)的患者,术后为避免131I清甲的潜在伤害可不清甲,而癌结节为>2 cm~≤3 cm者为减少复发建议行131I清甲治疗。Objective To investigate whether 131I therapy is necessary after thyroidectomy of single small cancerous node limited in one thyroid lobe. Methods Retrospective analysis was done in 105 patients, who had undergone subtotal or total thyroidectomy and been pathologically diagnosed as papillary thyroid carcinoma. All the patients were divided into three groups by nodule size： Group A （diameter, ≤ 1 cm）, Group B （1 cm 〈 diameter ≤2 cm）, and Group C （2 cm 〈 diameter ≤ 3 cm）. Each group continued to be divided into two groups according to taking or not taking radioactive 131I. Such parameters, as age, gender ratio, node position, operation method, follow-up time and recurrence number, were compared among the groups. Those who took 131I were evaluated in terms of the clearance of the residual thyroid for effects until complete clearance. Results In Group C, there were no significant differences between the patients taking 131I and the ones not taking 131I （ P 〉 0.05 ）. In group A, left lobe nodule was more common in the patients not taking 131I than in the ones taking 131I （P 〈0.01 ）. In Group C, total thyroidectomy was less performed in the patients not taking 131I than in the ones taking 131I （P 〈 0.01 ）. The median follow-up time was 73 months in the patients not taking 131 I, and 32 months in the ones taking 131I. There was no recrudesce in Group A and B. In Group C, there were 3 （18.8%） cases of recurrence in the patients not taking 131I and none in the ones taking 131I, between which the difference was not significant （P 〉 0.05）. Of the patients taking 131 I, 32 （72.8%） succeeded in clearance of the residual thyroids at a time, and 12 succeeded at the second time. Conclusion To avoid a potential damage, the patients with a single small cancerous node （ ≤ 2 cm） limited in one thyroid lobe do not need to conduct residual thyroid removing treatment, which is better to be done in the patient with cancerous node greater than 2 cm but not exceeding 3 cm for r

关 键 词：131碘 乳头状甲状腺癌 

分 类 号：R817.8[医药卫生—影像医学与核医学]