手术方式对分化型甲状腺癌^(131)I首次“清甲”疗效的影响  

The Influence of Operation Type on the Efficacy of the First ^(131)I Thyroid Ablation for Differentiated Thyroid Carcinoma

作　　者：闵文普 鲜于志群 别冬云[1] 韩云峰 高凌云 魏晓峰[1] MIN Wenpu;XIANYU Zhiqun;BIE Dongyun;HAN Yunfeng;GAO Lingyun;WEI Xiaofeng(Department of Nuclear Medicine,The First People’s Hospital of Jingzhou,Jingzhou Hubei 434000,China;Department of Nuclear Medicine,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan Hubei 430030,China)

机构地区：[1]荆州市第一人民医院核医学科,湖北荆州434000 [2]华中科技大学同济医学院附属同济医院核医学科,湖北武汉430030

出　　处：《中国继续医学教育》2021年第25期156-159,共4页China Continuing Medical Education

摘　　要：目的研究手术方式对分化型甲状腺癌(DTC)患者^(131)I首次“清甲”疗效影响。方法回顾性分析DTC术后接受^(131)I“清甲”治疗153例患者的临床资料。根据甲状腺平面显像结果分为腺叶切除不完全组(n=28)和腺叶切除完全组(n=125)。首次^(131)I“清甲”剂量:腺叶切除不完全组为80~100 mCi;腺叶切除完全组为100~200 mCi(“清甲”:100 mCi,“清甲”兼“清灶”:150~200 mCi)。6个月后刺激状况下复查并评估“清甲”效果:若Tg<10 ng/mL(需排除TgAb干扰),即行诊断剂量^(131)I全身显像(^(131)I-WBS),若显像示颈部无放射性摄取即认为“清甲”完全;若有放射性摄取,需行^(131)I治疗后平面显像+断层显像,确定浓聚灶为残留甲状腺组织还是转移灶,继而确定“清甲”是否完全;若Tg>10 ng/mL,则直接行治疗后平面显像+断层显像,确定是否有^(131)I浓聚灶,无浓聚灶则考虑病灶失分化可能;若有浓聚应考虑是残留甲状腺组织还是转移灶,继而确定“清甲”是否完全。结果1次“清甲”治疗的成功率:腺叶切除完全组为82.4%(103/125),腺叶切除不完全组为46.4%(13/28),差异具有统计学意义(P<0.05)。结论对于甲状腺腺叶切除完全的DTC患者,实施^(131)I治疗的一次“清甲”成功率高,腺叶切除不完全的DTC患者,实施^(131)I治疗的一次“清甲”成功率较低。Objective To investigate the influence of operation type on the efficacy the first ^(131)I thyroid ablation for differentiated thyroid carcinoma(DTC).Methods Clinical data of 153 cases of DTC patients who had undergone first ^(131)I remnant ablation therapy were retrospectively reviewed.According to the result of thyroid planar imaging,the cases were devided into partial thyroidectomy group(n=28)and complete thyroidectomy group(n=125).The first ablation doses were 80~100 mCi for partial thyroidectomy group and 100~150 mCi for complete thyroidectomy group respectively.The efficacy of ablation was evaluated by re-examination at stimulated thyroglobulin(Tg)level 6 months later.If the Tg was below 10ng/mL(the interference of TgAb should be eliminated),a ^(131)I whole-body scintigraphy(^(131)I-WBS)with the diagnostic dose would be conducted.The thyroid ablation was regarded as complete provided that residual radioactivity intake of thyroid was absent on ^(131)I systemic imaging,otherwise the post-^(131)I-therapy planar imaging and tomography imaging should be conducted to judge whether the high density focus was thyroid tissue residue or metastasis,and whether thyroidectomy was complete.If the Tg is above 10 ng/mL,the post-^(131)I-therapy planar imaging and tomography imaging should be immediately conducted to confirm the hot spots of ^(131)I intake.If the high density focus was absent,the probability of focal loss of differentiation should be taken into consideration.If the high density focus was present,it should be ascertained that whether it was thyroid tissue residue or metastasis,based on which whether thyroidectomy was complete would be ascertained.Results The success rate of thyroid remnant ablation of partial thyroidectomy group was 82.4%(103/125),while that of complete thyroidectomy group was 46.4%(13/28).The result had statistically significant differences(P<0.5).Conclusion The success rate of ^(131)I remnant ablation therapy within one dose is higher for a DTC patient having undergone complete thyroidectom

关 键 词：分化型甲状腺癌 甲状腺腺叶切除 放射性碘 清除甲状腺组织 内分泌恶性肿瘤 腺叶切除 

分 类 号：R736[医药卫生—肿瘤]