甲状腺微小乳头状癌^(131)I治疗后显像结果的临床分析  

Clinical Analysis of Imaging Results of Papillary Thyroid Microcarcinoma After ^(131)ITreatment

作　　者：谭支娥 代文莉[1] 王朋[1] 邓鹏裔 蒋长斌[1] 严凯[1] 胡涛[1] 谢珂 Tan Zhi’e;Dai Wenli;Wang Peng(Department of Nuclear Medicine,Yichang Central People’s Hospital,The First College of Clinical Medical Science,China Three Gorges University,Yichang Key Laboratory of Nuclear Medicine and Molecular Image,Yichang 443003,China)

机构地区：[1]三峡大学第一临床医学院,宜昌市中心人民医院核医学科,宜昌市核医学分子影像重点实验室,宜昌443003

出　　处：《华中科技大学学报（医学版）》2021年第5期645-648,653,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省自然科学基金资助项目(No.2018CFB147);宜昌市医疗卫生科研项目(No.A18-301-14,No.A19-301-08);宜昌市医疗卫生研究项目(No.A20-2-005)。

摘　　要：目的探讨^(131)I治疗后行全身显像(Rx-WBS)及SPECT/CT融合显像的甲状腺微小乳头状癌(PTMC)的病例特点,为指导临床治疗提供借鉴。方法回顾性分析2015年1月至2019年12月在宜昌市中心人民医院进行^(131)I清甲治疗的145例PTMC术后患者的临床资料。所有患者均在口服^(131)I后2~10d行Rx-WBS及SPECT/CT融合显像,根据显像结果分为残留甲状腺伴转移组(残甲伴转移组)21例和仅有残留甲状腺组织组(单纯残甲组)124例。分别比较两组患者的性别、年龄、手术方式、^(131)I治疗前刺激性甲状腺球蛋白(ps-Tg)、甲状腺球蛋白抗体(TgAb)、肿瘤病理特点(肿瘤最大直径、腺叶累及、多灶性、包膜外侵犯、淋巴结转移)。结果残甲伴转移组多为男性,与单纯残甲组比较,有更高的ps-Tg水平及更多的淋巴结转移数,而两组在年龄、手术方式、血清TgAb水平、肿瘤最大直径、腺叶受累情况、多灶性、甲状腺包膜外侵犯方面,差异无统计学意义(均P>0.05)。结论男性、高ps-Tg水平及高淋巴结转移数与PTMC ^(131)IRx-WBS及SPECT/CT融合显像发现转移灶相关,建议此类患者术后积极行^(131)I治疗。Objective To investigate the whole body scan(Rx-WBS)and SPECT/CT fusion imaging characterists of papillary thyroid microcarcinoma(PTMC)after 131Ⅰtreatment,and to provide some useful references for guiding clinical treatment.Methods The clinical data of 145 patients after PTMC who underwent ^(131)Itreatment in our department from January 2015 to December 2019 were retrospectively analyzed.All patients underwent Rx-WBS and SPECT/CT fusion imaging 2-10 days after oral ^(131)I.According to the imaging results,the patients were divided into two groups:the group with residual thyroid with metastasis(21 cases)and the group with residual thyroid tissue(124 cases).Gender,age,surgical approach,preablative stimulated thyroglobulin(ps-Tg),thyroglobulin antibody(TgAb)and tumor pathological characteristics(maximum tumor diameter,glandular involvement,multifocal,extrathyroid capsule invasion and lymph node metastasis)were compared between the two groups of patients,respectively.Results The residual thyroid with metastasis group was mostly male,compared with the residual thyroid group,and there were higher ps-Tg levels and more lymph node metastases.There was no statistically significant difference between the two groups in the age of onset,the surgical approach,the serum TgAb level,the maximum tumor diameter,the involvement of the glandular lobe,multifocal,extrathyroid capsule invasion and lymph node metastasis(all P>0.05).Conclusion Male,high ps-Tg level and high lymph node metastasis are related to metastases found on PTMC ^(131)I Rx-WBS and SPECT/CT fusion imaging.It is recommended that these patients be actively treated with ^(131)I after surgery.

关 键 词：甲状腺微小乳头状癌 体层摄影术 发射型计算机 单光子 体层摄影术 X线计算机 全身显像 

分 类 号：R736.1[医药卫生—肿瘤]