12例儿童甲状腺癌的临床诊断和治疗分析

Diagnosis and therapy of childhood thyroid carcinoma: clinical analysis of 12 cases

摘要:

目的：该研究旨在探讨儿童甲状腺癌的临床特点、诊断和治疗方法。方法：回顾性分析1998年8月至2008年8月在中南大学湘雅二医院乳腺甲状腺外科及小儿外科收治的14岁以下12例儿童甲状腺癌患者的临床资料。结果:儿童甲状腺癌与儿童良性甲状腺肿块首发症状均为无痛性肿块，但在肿块质地和颈淋巴结转移上差异有显著性（P＜0.05）。术前B超检查诊断符合率为75%，CT检查诊断符合率为83%，两者之间差异无显著性（P＞0.05）。病理诊断均为分化型甲状腺癌，其中乳头状癌7例，滤泡状癌3例，乳头状癌合并滤泡状癌2例。所有患者均行手术治疗及术后内分泌治疗，未行131I内放射治疗。手术方式主要选择单侧腺叶加峡部切除， 行功能性颈淋巴结清扫术10例（83%），颈淋巴结转移者9例（75%）。中位随访时间5年8个月（2个月至10年），5年及10年总生存率均为100%。结论：儿童甲状腺癌多为分化型，临床症状以质地坚硬及淋巴结转移多见为其特征，B超及CT检查结合可提高诊断甲状腺癌的准确性。选择合理治疗方案能取得满意疗效。［中国当代儿科杂志，2009，11（2）：120-123］

Abstract:

OBJECTIVE: To explore the clinical characteristics, diagnosis and therapy of thyroid carcinoma in children. METHODS: Clinical data of 12 children under the age of 14 years, diagnosed as thyroid carcinoma between August 1998 and August 2008, were reviewed. RESULTS: A hard thyroid mass was observed in 10 out of 12 children with thyroid carcinoma, but only one out of 15 children with benign thyroid tumor (P<0.05). The rate of cervical lymph node metastasis in children with thyroid carcinoma was significantly higher than that in children with benign thyroid tumor (P<0.05). There was no significant difference in the final diagnostic rate of thyroid carcinoma between ultrasonography and CT scans (75% vs 83%; P>0.05). All of 12 cases were pathologically confirmed as differentiated thyroid carcinoma, including papillary carcinoma (7 cases), follicular carcinoma (3 cases) and papillary-follicular carcinoma (2 cases). Nine patients (75%) had cervical lymph node metastasis. All patients received surgical treatment and postoperative thyroxin therapy. No patient was administered with postoperative radioiodine 131I therapy. Unilateral lobectomy plus isthmectomy along with a functional cervical lymph node dissection was a primary operation mode (83%). The follow-up period was 2 months to 10 years. The 5-and 10-year survival rates were 100%. CONCLUSIONS: Childhood thyroid carcinoma is mostly differentiated and characterized by hard thyroid mass and cervical lymph node metastasis. A combination of ultrasonography and CT is helpful to the diagnosis of childhood thyroid carcinoma. The treatment outcome may be satisfactory by optimal therapy in children with thyroid carcinoma.［Chin J Contemp Pediatr, 2009, 11 (2):120-123］