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甲状腺癌是内分泌系统最常见的肿瘤, 占恶性肿瘤总数的2.3%[1]。近年来, 甲状腺癌的发病率呈上升趋势。分化型甲状腺癌(differentiated thyroid carcinoma, DTC)包括乳头状甲状腺癌(papillary thyroidcarcinoma, PTC)和滤泡性甲状腺癌(follicularthyroidcarcinoma, FTC), 占所有甲状腺恶性肿瘤的80%以上, “手术+促甲状腺激素(thyroid-stimulatinghormone, TSH)抑制+131I治疗”的综合治疗方法是目前公认的DTC根治方案[2-3]。虽然DTC的恶性程度不高, 而且病程缓慢, 但是由于其具有多灶性的特点, 故仍然有部分患者在手术后出现复发或转移。因此, 专业学者均主张手术后给予131I治疗。
从整个治疗过程来看, 131I治疗包括两个关系密切的阶段, 即131I清除甲状腺癌术后残留甲状腺组织(清甲)阶段和131I治疗甲状腺癌转移病灶(清灶)阶段。清甲治疗是DTC术后的首选治疗, 采取最佳的清甲方案以获得首次清甲的成功是非常必要的, 不仅避免了患者所受辐射剂量的增加, 还直接影响下一步治疗、随诊方案的顺利进行。
分化型甲状腺癌术后131I清甲效果的影响因素
Influencing factors of radioiodine ablation of posts-urgical thyroid remnants in differentiated thyroid carcinoma
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摘要: 利用131I清除甲状腺癌术后残留甲状腺组织(清甲)是分化型甲状腺癌(DTC)术后治疗中的重要步骤。清甲效果受诸多因素影响,包括口服131I的剂量、DTC的手术方式、术后甲状腺组织残留量、血清促甲状腺激素(TSH)与甲状腺球蛋白(Tg)水平、有无淋巴结及远处转移、手术距131I治疗时间的长短等。使用较大剂量131I进行清甲、采取甲状腺全切或近全切除术方式、131I治疗前较高水平的TSH, 以及术后及时开始131I治疗等有助于提高清甲成功率。131I治疗前患者血清Tg水平偏高或存在转移灶,应适当加大131I治疗剂量。患者性别、年龄、病理类型等对清甲成功与否无明显影响。Abstract: Radioiodine ablation of thyroid remnants after surgery is an important part of the treatment of differentiated thyroid carcinoma.The effect of ablation therapy is affected by many factors, such as the administration dose of radioiodine, mode of operation, amount of thyroid remnants, the serum level of thyroidstimulating hormone and thyroglobulin, whether lymph nodes or distant metastasis are existed, the period of time between the ablation treatment and the operation and so on.Relative high dose of radioiodine, total or near-total thyroidectomy, high level of thyroid-stimulating hormone, ablation treatment onset after surgery without delay would contributed to the success of thyroid ablation.If the patient's thyroglobulin levels are high or metastasis foci are existed, the dose of radioiodine should increase to some extent.While patient's gender, age and pathology are unrelated to the treating effect.
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Key words:
- Thyroid neoplasms /
- Iodine radioisotopes /
- Surgical procedures, operative /
- Brachytherapy
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