131I和手术治疗乳头状甲状腺癌的临床价值探讨

摘要

Objective To investigate the clinical value of surgical treatment combined with 131I in the treatment of thyroid papillary carcinoma. Methods 55 cases of papillary thyroid cancer patients were selected from January 2008 to June 2011 in our hospital and were retrospectively analyzed. 55 cases of patients were treated with total thyroidectomy surgical ,postoperative underwent thyroid hormone and 131I radionuclide therapy,The patients were followed up. Results 50 cases of patients received surgical treatment for the first time,5 cases for the second surgery,surgical complications were mainly laryngeal recurrent nerve injury in 9 cases,permanent hoarseness in 2 cases,hypocalcemic seizures in 3 cases, and 14 patients received modified neck lymph node dissection. At 3 months or 6 months after operation,the levels of serum p53,Fas and TNF-a were significantly higher than immediate time after surgery (P < 0.05) and cyclinE protein levels were significantly lower than immediate time after surgery (P < 0.05). There were no difference of serum P53,Fas,TNF-and CyclinE protein levels between at 3 months and 6 months after operation(P>0.05). During 5 years of follow-up, 5 cases were lost,and the 5-year recurrence rate of 4.00%(2/50),including 1 case at 41 months and 1 case at 56 months after operation. And the distant metastasis rate was 2.00%(1/50). Conclusion Operation combined with 131I radionuclide therapy has better clinical results than single treatment, and can reduce CyclinE protein levels and increase serum P53 , Fas and TNF-αlevels.%目的 探讨甲状腺乳头状癌患者采取手术治疗联合131I核素治疗的临床价值.方法 选取2008年1月~2011年6月在辽宁省肿瘤医院诊治的甲状腺乳头状癌患者55例进行回顾性分析,55例患者均采取甲状腺全切手术治疗,术后均接受甲状腺激素和131I核素治疗,观察患者的治疗效果.结果 50例患者为首次接受手术治疗,5例为第二次手术治疗,手术并发症主要为喉返神经损伤9例、永久性声音嘶哑2例、低钙血症抽搐3例,有14例患者同时接受改良颈部淋巴结清扫术.术后3个月、6个月,患者的血清肿瘤抑制基因(P53)、细胞凋亡信号受体(Fas)、肿瘤坏死因子α(TNF-α)水平显著高于术后即刻(P<0.05),细胞周期素E(Cyclin E)蛋白水平显著低于术后即刻(P<0.05);术后3个月与术后6个月,患者的血清P53、Fas、TNF-α、Cyclin E蛋白含量差异无统计学意义(P>0.05);5年随访,失访5例,5年复发率4.00%(2/50)、远处转移率2.00%(1/50),其中1例患者于术后41个月时复查出现复发,1例于56个月时出现转移.结论 甲状腺乳头状癌患者采取手术联合131I核素治疗具有较好的临床效果,同时能降低Cyclin E蛋白水平和提高血清P53、Fas、TNF-α水平.