摘要 目的：探讨儿童甲状腺肿瘤的临床特征及诊断与治疗。方法：回顾性分析2002年1月至2010年12月中南大学湘雅医院经手术治疗的32例甲状腺肿瘤患儿的临床资料。结果：32例患儿中，女性23例，男性9例。经病理证实良性肿瘤6例，恶性26例。良性病例均诊断为腺瘤性结节性甲状腺肿，恶性均为甲状腺乳头状癌。B超对甲状腺恶性肿瘤的诊断率高达100%。14例患儿合并桥本氏甲状腺炎（44%）。22例患儿伴有同侧颈淋巴结转移（69%）。年龄在10岁以下者发生颈部淋巴结转移的比例较10岁以上者高（94% vs 56%，P＜0.05）。32例患儿均接受手术治疗。对6例良性病变患儿实施肿块侧腺叶次全切除术；对26例恶性病变患儿根据肿瘤不同进展阶段实施双侧甲状腺全切（17例）或患侧甲状腺全切（9例）。经随访3个月至9年，无复发、死亡病例，患儿生长发育正常。结论：儿童甲状腺肿瘤女性多见，恶性病变比例高；常合并桥本氏甲状腺炎；年龄在10岁以下者易发生局部淋巴结转移。手术是治疗甲状腺肿瘤的有效方法。
Abstract：OBJECTIVE: To study the clinical features, diagnosis and therapy of thyroid neoplasm in children. METHODS: A retrospective study was performed on 32 children with thyroid nodular who were underwent operation in Xiangya Hospital between January 2002 and December 2010. RESULTS: Of the 32 cases, there were 23 girls and 9 boys. Six cases were diagnosed as nodular Goiter adenoma and 26 cases were diagnosed as thyroid papillary carcinoma. B-ultrasonic examination showed a 100% accurate rate for the diagnosis of thyroid carcinoma. Fourteen children (44%) were proven to have concurrent Hashimoto′s thyroiditis. Twenty-two (69%) children with thyroid carcinoma were found to have lymph metastasis in the lateral neck. The children younger than 10 years showed a high rate of metastasis than those older one (94% vs 56%, P＜0.05). All 32 children received a surgical therapy. Subtotal thyroidectomy was performed on the 6 children with nodular Goiter adenoma. Total thyroidectomy (17 cases) or ipsilateral thyroidectomy (9 cases) was performed according to the stage of thyroid carcinoma. The surgical outcomes were followed up for 3 months to 9 years and no recurrence or death occurred. The development and growth were normal in the children. CONCLUSIONS: Childhood thyroid nodular attacks girls more than boys, and the frequency of malignancy is high. Hashimoto′s thyroiditis is a common concurrent disease. The incidence of local lymph metastasis is high in those younger than 10 years. The surgical therapy for thyroid neoplasm may lead satisfactory outcomes in children.
CHANG Shi,DENG Zhen-Han,DONG Chao et al. Clinical features and experience of diagnosis and treatment of thyroid neoplasm in children[J]. CJCP, 2011, 13(9): 736-739.
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