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目的探讨手术联合131I治疗分化型甲状腺癌(DTC)的临床效果。方法选择2000年1月—2004年12月收治DTC患者142例,均行甲状腺次全切除或甲状腺全切加颈淋巴结选择性清扫术。术后90例行131I治疗,加甲状腺素片替代治疗清除剩余甲状腺组织或治疗转移灶(清甲)(A组);52例未行131I治疗,仅予甲状腺素片替代治疗(B组)。结果 A组在清甲1~4次后均获得成功,首次清甲成功率为71.1%。A组131I转移灶治疗总有效率为91.1%,有效率依次为:颈淋巴结转移(95.1%)>肺转移(88.9%)>骨转移(72.7%);不良反应发生率为:全切除42.0%,次全切77.5%,差异有统计学意义(P<0.01);A组术后10年复发转移率和生存率分别为6.7%和94.4%,B组10年复发转移率和生存率分别为19.2%和80.8%,差异均有统计学意义(均P<0.05)。结论手术联合131I加甲状腺激素替代治疗,清甲和转移灶疗效显著,能有效减低DTC术后复发和转移率,有较好的远期疗效。
Objective To investigate the clinical effects of surgery combined with 131I in the treatment of differentiated thyroid cancer (DTC). Methods From January 2000 to December 2004, 142 patients with DTC were enrolled in this study. All patients underwent total thyroidectomy or total thyroidectomy with cervical lymph node dissection. After operation, 131 cases were treated with 131I, and thyroid hormone replacement therapy was used to remove residual thyroid tissue or to treat metastasis (A); 52 cases were treated with 131I instead of thyroid hormone replacement therapy (B group). Results Group A was successful after 1 ~ 4 times of Chlorella, the success rate of first time was 71.1%. The total effective rate of 131I metastases in group A was 91.1%. The effective rates were as follows: cervical lymph node metastasis (95.1%), lung metastasis (88.9%), bone metastasis (72.7%). The incidence of adverse reactions was 42.0% , Subtotal 77.5%, the difference was statistically significant (P <0.01); A group of 10-year recurrence and metastasis rates and survival rates were 6.7% and 94.4%, respectively, 10-year group B recurrence and metastasis rates and survival rates were 19.2% and 80.8%, respectively (all P <0.05). Conclusions The combined operation of 131I and thyroid hormone replacement therapy, clear armor and metastasis significant effect, can effectively reduce the recurrence and metastasis after DTC, have a good long-term efficacy.