
12例儿童甲状腺癌的临床诊断和治疗分析
徐峰, 刘斌, 陈显玉, 周恩相, 范丹凤, 马勇, 唐中华
中国当代儿科杂志 ›› 2009, Vol. 11 ›› Issue (02) : 120-123.
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
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]
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]
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