Karnak Ibrahim, Ardıçlı Burak, Ekinci Saniye, Ciftçi Arbay Ozden, Orhan Diclehan, Kale Gülsev, Tanyel Feridun Cahit, Senocak Mehmet Emin
Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Pediatr Surg Int. 2011 Sep;27(9):931-6. doi: 10.1007/s00383-011-2932-2. Epub 2011 May 24.
Papillary thyroid carcinoma has a favorable outcome in children. Recent experience with young children cases with early recurrences, after the total thyroidectomy and excision of palpable lymph nodes, in contrast to usual course of disease in adolescent cases, prompted us to review our experience on papillary carcinoma surgery.
Sixteen children who underwent surgery for papillary carcinoma between 1997 and 2010 were included. The charts and surgery notes were evaluated retrospectively and age, sex, complaints and physical findings at presentation, past medical history, results of laboratory tests, imaging findings, aspiration biopsy, extent of disease, details of surgery, complications and postoperative course were noted.
Male to female ratio was 3:1. The mean age was 10.9 years (range, 5-16). The presenting symptom was palpable swelling in the neck (n = 12) or asymptomatic nodule was detected incidentally (n = 4). Physical examination findings were palpable nodule (n = 7), lymphadenopathy (n = 6) or both (n = 4). Thyroid ultrasound (US) revealed nodule (n = 9), heterogenisity of the parenchyma and enlargement of thyroid (n = 9), and microcalcifications (n = 5). Fine-needle aspiration biopsy was performed in 12 patients and was suggestive for malignancy in most cases (91%). Pulmonary metastasis was detected at presentation in two patients and appeared after thyroidectomy in one patient. Complementary thyroidectomy was performed in nine patients because the total thyroidectomy with or without cervical lymph node dissection was the treatment of choice (n = 15). Iodine scan was performed 4 weeks later following thyroidectomy. Radioactive iodine ablation (RIA) therapy was given to 11 patients who had residual or recurrent disease. Postoperative complications were permanent hypoparathyroidism (n = 4), recurrent laryngeal nerve injury (n = 3), lymphorea (n = 1) and Horner's syndrome (n = 1).
Total thyroidectomy and excision of affected lymph nodes is the current mode of surgical management for thyroid papillary carcinoma in children. However, especially in young children (<10 years), modified lymph node dissection should be added to total thyroidectomy in order to avoid leaving the residual tumor foci which can impair the efficacy of the ablation therapy.
儿童甲状腺乳头状癌预后良好。近期，幼儿甲状腺全切及可触及淋巴结切除术后早期复发的病例经验，与青少年病例的疾病通常病程形成对比，促使我们回顾甲状腺乳头状癌手术的经验。
纳入1997年至2010年间接受甲状腺乳头状癌手术的16名儿童。回顾性评估病历和手术记录，记录年龄、性别、就诊时的主诉和体格检查结果、既往病史、实验室检查结果、影像学检查结果、细针穿刺活检、疾病范围、手术细节、并发症及术后病程。
男女比例为3:1。平均年龄为10.9岁（范围5 - 16岁）。主要症状为颈部可触及肿物（n = 12）或偶然发现无症状结节（n = 4）。体格检查发现可触及结节（n = 7）、淋巴结病（n = 6）或两者皆有（n = 4）。甲状腺超声（US）显示结节（n = 9）、实质不均质及甲状腺肿大（n = 9）和微钙化（n = 5）。12例患者进行了细针穿刺活检，多数病例（91%）提示恶性。2例患者就诊时发现肺转移，1例患者甲状腺切除术后出现肺转移。9例患者进行了补充甲状腺切除术，因为甲状腺全切术加或不加颈部淋巴结清扫是首选治疗方法（n = 15）。甲状腺切除术后4周进行碘扫描。11例有残留或复发病变的患者接受了放射性碘消融（RIA）治疗。术后并发症包括永久性甲状旁腺功能减退（n = 4）、喉返神经损伤（n = 3）、淋巴漏（n = 1）和霍纳综合征（n = 1）。
甲状腺全切术及切除受累淋巴结是目前儿童甲状腺乳头状癌的手术治疗方式。然而，尤其是年幼患儿（<10岁），甲状腺全切术应加行改良淋巴结清扫，以避免残留肿瘤病灶，否则会影响消融治疗的疗效。
