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2020年全球新发58万甲状腺癌病例,其发病率在所有恶性肿瘤中位居第11位[1]。2022年我国国家癌症中心报告了2016年全国癌症的发病率和病死率情况,数据显示我国甲状腺癌的发病率在所有恶性肿瘤中居第7位,在女性恶性肿瘤中居第4位[2]。DTC是甲状腺癌最常见的病理类型,可分为甲状腺乳头状癌和甲状腺滤泡状癌,其中甲状腺乳头状癌最常见,约占所有甲状腺恶性肿瘤的85%。与其他常见的恶性肿瘤相比,DTC预后较好,经外科手术为主的综合治疗后,患者的10年生存率可达93%。术后持续性和(或)复发性疾病可表现为局部晚期原发肿瘤、颈部淋巴结转移(cervical lymph nodes metastases,CLNM)和(或)远处转移[3]。约30%的DTC患者会出现持续性和(或)复发性疾病,其中约2/3发生在术后10年内[4-6]。最常见的术后持续性和(或)复发性疾病是CLNM,也称为区域复发,常见于甲状腺乳头状癌,约占颈部复发疾病的74%[6]。
分化型甲状腺癌术后持续性和(或)复发性颈部淋巴结转移的诊疗
Diagnosis and treatment of postoperative persistent/recurrent cervical lymph nodes metastases in differentiated thyroid cancer
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摘要: 近年来,由于高分辨率超声及细针穿刺抽吸细胞学检查被广泛应用于临床,分化型甲状腺癌(DTC)的检出率显著增加。颈部淋巴结转移(CLNM)是DTC患者术后出现持续性和(或)复发性疾病的最常见类型,其诊疗涉及众多学科。目前诊断CLNM最常用的方法为颈部超声,“金标准”是组织病理学检查,主要的治疗方法仍是手术,131I治疗、超声引导下的消融术治疗及随访观察等代替手术的治疗手段亦逐渐被提出并应用于临床。笔者就DTC术后持续性和(或)复发性CLNM的诊疗作一综述。Abstract: In recent years, the detection rate of differentiated thyroid cancer (DTC) has increased significantly due to the wide application of high-resolution ultrasonography and fine needle aspiration biopsy. Cervical lymph nodes metastases (CLNM) is the most common type of postoperative persistent/recurrent disease in DTC patients, and its diagnosis and treatment involve multiple disciplines. At present, the most common diagnostic method and the "gold standard" is cervical ultrasound and histopathological examination respectively. The main treatment is operation. In addition, some alternative treatments such as 131I therapy, ultrasound-guided ablation and follow-up observation have gradually been proposed and applied in clinical practice. The authors review the diagnosis and treatment of postoperative persistent/recurrent CLNM in DTC patients.
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Key words:
- Differentiated thyroid cancer /
- Lymph nodes metastases /
- Recurrence /
- Diagnosis /
- Therapy /
- Persistent
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