儿童分化型甲状腺癌29例临床病例分析

摘要

目的 分析儿童分化型甲状腺癌的临床表现、治疗方法及其结果,探讨其最佳治疗方式.方法 对上海交通大学医学院附属新华医院耳鼻咽喉头颈外科1998年1月-2014年7月收治的14岁以下的29例儿童分化型甲状腺癌的临床表现、治疗方法及其结果等进行回顾性分析.结果 29例患儿中,以“发现颈部肿块”为主诉者27例;单侧甲状腺癌16例,双侧甲状腺癌13例;甲状腺实质性肿块伴多发点状钙化者21例(72.4％);颈淋巴结肿大者24例(82.8％),其中仅患侧肿大者9例(37.5％),双侧均肿大者15例(62.5％).我院初治患儿20例中,T2及其以上者18例,颈淋巴结肿大者16例.行甲状腺患侧腺叶+峡部切除术者2例,甲状腺全切除术者18例,其中1例气管壁受肿瘤侵犯者同时行气管部分切除术;同时行颈清扫术者16例.在外院接受过原发灶手术的9例患儿中,术后出现颈淋巴结肿大者8例,伴发肺转移者6例;行颈清扫术5例,残留甲状腺切除术+颈清扫术4例.术后行131I治疗者总共27例.术后随访率100％,随访时间平均6年10个月(0.5 ～16.0年),无死亡病例发生,亦无复发、局部及远处转移.结论 儿童分化型甲状腺癌侵犯性明显强于成人,甲状腺全切除术+颈清扫术辅以术后131I治疗可作为其基本治疗方案.%Objective To explore the best administration for the differentiated thyroid cancer in children under 14 years by reviewing of their clinical characteristics,treatment methods and results.Methods Clinical data of 29 patients under 14 years with differentiated thyroid cancer in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine between Janury 1998 and July 2014 were reviewed respectively.Results Neck mass was the chief complaint in 27 of 29 patients.Unilateral thyroid carcinoma was found in 16 cases,and bilateral in 13 cases.Solid tumor with multiple punctate calcification was observed in 21 cases (72.4％).Cervical lymph nodes enlargement was found in 24 cases (82.8％),and 15 cases (62.5％) were bilateral.Among 20 patients received primary thyroid surgery in our hospital,18 cases presented with T2 or advanced diseases and 16 cases had cervical lymph nodes enlargement.The resection of unilateral lobe with isthmus was performed in 2 cases,and total thyroidectomy in 18 patients,including 1 case with partial trachea resection.Neck dissection was performed in 16 patients.Of 9 patients received primary thyroid surgery in other hospitals,8 cases presented with cervical lymph node enlargement after surgery and 6 cases with pulmonary metastasis,of them 5 patients received neck dissection,4 patients underwent resection of residual thyroid cancer plus neck dissection.Twenty-seven of all patients were treated postoperatively with 131I.All patients received follow-up,and the meaning follow-up time was 6 years and 10 months (0.5 years-16 years).No cases with death,local recurrence,and metastasis were observed in the follow-up peroid.Conclusions Differentiated thyroid cancer is more invasive in children compared with adults.Comprehensive treatment including total thyroidectomy,neck dissection and postoperative 131I therapy may be a basic approach for the differentiated thyroid cancer in children.