青少年及儿童分化型甲状腺癌临床特征及治疗策略  

The clinical characteristics and treatment strategies of differentiated thyroid carcinoma in adolescents and children

作　　者：李树春[1] 李振东[1] 刘宏伟[1] 董慧蕾[1] 许阳[1] 

机构地区：[1]中国医科大学肿瘤医院辽宁省肿瘤医院头颈外科,沈阳110042

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第6期431-437,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨青少年及儿童分化型甲状腺癌患者的临床特征和治疗策略。方法:我科1983-2014年间共收治2 936例甲状腺癌患者,其中有85例青少年及儿童分化型甲状腺癌,其中女61例,男24例;年龄9~21岁(中位年龄18.3岁),≤14岁者12例。85例中乳头状癌76例,滤泡状癌9例。对85例患者的临床资料、病史、症状表现、TNM分级、组织病理学特征、治疗方法和最后转归随访结果进行分析和研究。结果:85例青少年及儿童患者生存率为100%,随访0.5~31.0年,中位随访10.9年,10年肿瘤无进展生存率为87.1%。全组无死亡病例,出现复发患者8例(9.4%),均经再次手术治愈。有甲状腺外广泛侵犯者20例,其中≤14岁者甲状腺被膜外侵率为66.7%(8/12),明显高于≥15岁以上者的16.4%(12/73),二者差异有统计学意义(P<0.01)。有淋巴结转移者49例(57.6%),其中≤14岁者转移率占92.0%(11/12),高于≥15岁以上者的52.1%(38/73),差异有统计学意义(P<0.05)。3例在就诊时发现有肺转移,均为≤14岁患者。85例患者均进行了手术治疗,原发病灶甲状腺切除范围包括甲状腺全切、次全切和一侧腺叶切除。颈淋巴结清除方式包括改良式颈清扫、根治式颈清扫以及无颈淋巴清扫手术。全组术后接受131I放疗者15例,一次量50~170mCi。85例患者术后均给予甲状腺刺激素抑制治疗。术后出现各种并发症13例(15.3%),常见为喉返神经麻痹和低血钙症。结论:青少年及儿童甲状腺癌多为乳头状癌,其次为滤泡状癌,容易发生甲状腺包膜外侵犯,淋巴结和远处转移率很高,尤其是≤14岁的儿童患者比≥15岁者更为明显,但预后良好很少因甲状腺癌死亡。主要依靠外科手术彻底切除治疗,除有远处转移和肿瘤广泛周围侵犯者需行甲状腺全或次全切除,并注意保留喉返神经和甲状旁腺功能外,多数患者局限在一侧叶者可行单侧腺叶切除。颈淋巴结转移需做改良式颈清扫,尽Objective：To study the clinical characteristics and treatment strategies of differentiated thyroid carcinoma in adolescents and children.Method：From 1983 to 2014,total 2936 patients with the thyroid cancer were collected in our hospital,among which there were 85 patients of adolescents and children with 61 female and24male.The age was from 9to 21 years old（median 18.3years）.There were 12 cases less than 14 years.The pathologic diagnoses were papillary carcinoma 76 cases and follicular carcinoma 9cases.The clinical material,history of disease,clinical presentation,TNM classification,histopathological features,treatment method,and the final follow-up results were analyzed and studied.Result：Overall survival rate was 100%,follow-up from 0.5to 31years（medium 10.9years）,10 year progression free survival rate was 87.1%.There was no mortality and 8（9.4%）cases occurred recurrence,who followed by surgery and resumed finally.There were 20 cases found extrathyroid extention,including 8cases less than 14 years and 12 cases older than 15 years.The extrathyroid extention rate was significantly higher in cases of lower years（66.7%）than other group（16.4%）（P〈0.01）.Forty-nine（57.6%）cases were found lymphanods metastases,among them ≤14years metastases rate 92.0%（11/12）significantly more than ≥15years metastases rate 52.1%（38/73）（P〈0.05）.Three patients suffered with pulmonary metastases and all of them were≤14years patients.All of 85 patients were received surgery treatment included total,subtotal and oneside thyroidectomy.The neck lymph nodes were underwent modefied,radical or no neck dissection.Fifteen patients were received 131 I therapy postoperatively,the dosage was 50-170mCi.All of 85 patients were received TSH suppression therapy.13cases（15.3%）occurred complications,such as laryngeal recurrent nerve paralysis and hypoparathyroidism commonly.Conclusion：Majority of thyroid cancer for adolescents and children are papillary and follicular carcinoma.The histopathologic

关 键 词：甲状腺肿瘤 青少年 儿童 外科手术 治疗策略 

分 类 号：R736.1[医药卫生—肿瘤]