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目的总结青少年分化型甲状腺癌的诊治经验。方法回顾性分析我院1983年至2000年青少年分化型甲状腺癌的临床资料及随访结果。结果全组均行手术治疗辅以内分泌治疗,76例青少年分化型甲状腺癌中,病理示乳头状癌66例(86.8%),滤泡状腺癌10例(13.2%)。淋巴结转移者46例(60.5%)。手术方式包括单侧病变行患侧腺叶加峡部及对侧大部切除45例(其中行功能性颈清扫术42例),患侧腺叶加峡部切除12例(其中行患侧功能性颈清扫术10例);双侧病变行一侧腺叶+峡部及对侧大部切除加双侧功能性颈清扫术10例,甲状腺全切术加双侧颈清扫术9例(其中3例一侧功能性清扫、另一侧根治性清扫);2例肺转移患者行甲状腺全切及颈部淋巴结清扫术后行131I内放射治疗。74例获得随访,随访5～14年,中位随访时间7.8年,其中6例获得10年以上随访,5年生存率97.3%,10年生存率83.3%。结论青少年分化型甲状腺癌预后较佳,治疗的关键是正确根据其病情选择合适的手术方式。
Objective To summarize the diagnosis and treatment of adolescent differentiated thyroid cancer. Methods The clinical data and follow-up results of adolescent differentiated thyroid cancer from 1983 to 2000 in our hospital were retrospectively analyzed. Results All the patients underwent surgical treatment combined with endocrine therapy. Among 76 adolescent differentiated thyroid carcinomas, 66 (86.8%) had papillary thyroid carcinoma and 10 (13.2%) had follicular adenocarcinoma. 46 cases of lymph node metastasis (60.5%). Surgical methods include unilateral lesions of the ipsilateral lobes plus isthmus and the contralateral maxillary resection in 45 cases (including 42 cases of functional neck dissection), ipsilateral lobes plus isthmic resection in 12 cases (of which the ipsilateral functional neck 10 cases of dissection); bilateral lesion side of the gland and isthmus + isthmus and contralateral maxillary resection plus bilateral functional neck dissection in 10 cases, total thyroidectomy plus bilateral neck dissection in 9 cases (of which 3 cases Lateral functional cleaning, the other side of the radical cleaning); 2 cases of lung metastases underwent total thyroidectomy and cervical lymph node dissection after 131I radiation therapy. 74 patients were followed up for 5 to 14 years. The median follow-up time was 7.8 years. Six of them were followed up for more than 10 years. The 5-year survival rate was 97.3% and the 10-year survival rate was 83.3%. Conclusion The prognosis of adolescent differentiated thyroid cancer is better. The key to treatment is to choose the proper surgical method according to its condition.