论文部分内容阅读
目的探讨治疗分化型甲状腺癌的疗效。方法采用回顾性分析方法,将行甲状腺次全切除术或全切术并经病理确诊为甲状腺乳头状癌或滤泡状癌患者498例,于131I治疗前1个月禁食含碘食物、药物、优甲乐,使血清中TSH≥30 mU/L。采用131I一次口服,“清甲”、淋巴结转移、远处脏器转移剂量分别为3.7、5.55、7.4 GBq。131I治疗后7 d,行全身ECT扫描,若患者体内有核素浓集,4个月后再次服131I。结果 31～50岁发病人数占63.5%。行次全切、次全切+单侧颈廓清、全切、全切+单侧颈廓清、全切+双颈廓清术分别为85、62、251、72、28例。行1、2、3次手术者分别为451、39、8例。有、无颈部淋巴结转移者分别为419、79例。甲状腺内有一个癌结节者130例,一叶内有2个癌结节者59例,左右叶内各有1个及以上癌结节者309例。癌结节有、无局部侵犯者分别为139、359例。乳头状、滤泡状、乳头+滤泡状癌分别为464、25、9例。Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为61、155、268、14例。有远处转移患者共14例。274例患者2次服131I后、130例患者3次服131I后、58例患者4次服131I后、20例患者5次服131I后、5例患者6次服131I后ECT扫描证实全身无核素浓集,其中3例肺转移患者6次服131I后ECT扫描证实全身无核素浓集,11例骨转移或肺转移患者服131I后ECT扫描证实仍有核素浓集。结论131I是分化型甲状腺癌术后治疗的有效方法。甲状腺残留多、有局部侵犯的患者,会增加服131I的次数。有远处转移的甲状腺癌患者仍有治愈可能,但是有肺、骨等远处转移的患者仍是治疗的难点。
Objective To investigate the treatment of differentiated thyroid cancer. Methods A retrospective analysis was performed in 498 patients with thyroid papillary carcinoma or follicular carcinoma who underwent subtotal thyroidectomy or total resection. The animals were fasted with iodine-containing food and drugs , Euthyrox, serum TSH ≥ 30 mU / L. Using 131I once oral, “” A ", lymph node metastasis, remote organ metastasis doses were 3.7,5.55,7.4 GBq. Seven days after 131I treatment, a total body ECT scan was performed. If the patient had a concentration of nuclide, 131I was given again after 4 months. Results The number of patients aged 31 to 50 accounted for 63.5%. Full subtotal, subtotal cut + unilateral neck clearance, total cut, full cut + unilateral neck clearance, total cut + double neck clearance surgery were 85,62,251,72,28 cases. Row 1, 2 and 3 times were 451,39 cases, 8 cases. Yes, no neck lymph node metastasis were 419,79 cases. Thyroid there is a cancer of the nodules in 130 cases, a leaf in two cancer nodules in 59 cases, each of the left and right leaves one or more cancer nodules in 309 cases. Cancer nodules, no local violations were 139,359 cases. Papillary, follicular, nipple + follicular carcinoma were 464,25,9 cases. Patients in stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 61,155,268 and 14 cases respectively. A total of 14 patients with distant metastasis. 274 patients after two 131I, 130 patients after three doses of 131I, 58 patients after 4 doses of 131I, 20 patients after 5 doses of 131I, 5 patients 6 times after 131I ECT scan confirmed that the whole body without nuclear Eleven patients with lung metastases were subjected to 131I ECT scan to confirm the whole body was non-radionuclide concentration. Eleven patients with bone metastases or lung metastases confirmed the presence of radionuclides by ECT after 131I. Conclusion 131I is an effective method for postoperative treatment of differentiated thyroid cancer. Thyroid residue, there are local violations of patients, will increase the number of service 131I. Thyroid cancer patients with distant metastasis may still be cured, but patients with distant metastases such as lung and bone are still difficult to treat.