甲状腺癌肺转移诊断及治疗  

Surgical diagnosis and treatment of thyroid cancer with lung metastasis

作　　者：李建波 章德广[1] LI Jian-bo;ZHANG De-guang(Department of Head and Neck Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院头颈外科,浙江杭州310000

出　　处：《中国实用外科杂志》2024年第6期705-708,共4页Chinese Journal of Practical Surgery

基　　金：浙江省科技厅省级重点研发计划(No.2022C03089)。

摘　　要：甲状腺癌是内分泌系统中常见的恶性肿瘤,其发病率逐年上升。根据组织来源不同,甲状腺癌可分为分化型甲状腺癌(DTC)、甲状腺髓样癌(MTC)和甲状腺未分化癌(ATC)。不同类型的甲状腺癌在分化程度、肿瘤学行为及侵袭性方面存在差异,其诊断、治疗和预后也各不相同。肺是甲状腺癌常见的远处转移部位,尤其是DTC,虽然恶性度相对低,但仍有5.2%的病人会发生肺转移。MTC和ATC的恶性度更高,侵袭性更强,更易转移到肺部。早期诊断和规范治疗对提高病人生活质量和降低死亡率至关重要。外科手术切除肺内转移灶可获得良好的生存率,但对于多发或弥漫性转移以及其他部位远处转移的病人,手术可能无法实施,此时需采用放射性^(131)I治疗、促甲状腺激素(TSH)抑制、靶向治疗、放化疗等方法。甲状腺癌肺转移的治疗需要综合考虑肿瘤类型、转移程度和病人个体情况,以制定合理的治疗方案。Thyroid cancer is a common malignancy within the endocrine system,and its incidence has been rising annually.Based on tissue origin,thyroid cancer can be classified into differentiated thyroid cancer(DTC),medullary thyroid cancer(MTC),and anaplastic thyroid cancer(ATC).These types of thyroid cancer vary in terms of differentiation,oncological behavior,and aggressiveness,which also leads to differences in diagnosis,treatment,and prognosis.The lungs are the most common site of distant metastasis for thyroid cancer,especially DTC.Although DTC is relatively less malignant,5.2%of patients still experience lung metastasis.MTC and ATC are more malignant and aggressive,making them more likely to metastasize to the lungs.Early diagnosis and standardized treatment are crucial for improving patient quality of life and reducing mortality rates.Surgical resection of pulmonary metastases can yield favorable survival rates,but surgery may not be feasible for patients with multiple or diffuse metastases or distant metastases to other sites.In such cases,treatment options include radioactive iodine-131 therapy,TSH suppression,targeted therapy,and radiochemotherapy.The treatment of thyroid cancer lung metastasis requires a comprehensive consideration of tumor type,the extent of metastasis,and individual patient circumstances to formulate a reasonable treatment plan.

关 键 词：甲状腺癌 分化型 肺转移 外科治疗 诊断方法 甲状腺髓样癌 甲状腺未分化癌 生存率 

分 类 号：R6[医药卫生—外科学]