Lin J D, Chao T C, Huang M J, Weng H F, Tzen K Y
Department of Internal Medicine, Chang Gung Memorial Hospital, Taiwan, ROC.
Am J Clin Oncol. 1998 Feb;21(1):77-81. doi: 10.1097/00000421-199802000-00018.
Complete thyroidectomy was recommended for patients with well-differentiated thyroid carcinoma to remove any potential residual contralateral cancer tissue and to facilitate detection of metastatic lesions by radioactive iodide (131I). Unfortunately, 8-32% incidence of severe complications were noted after reoperation. At present, there are still not enough data about the ablative effect of 131I for such conservative surgical treatment of well-differentiated thyroid cancers. The major goal of the present study was to examine the effects of 311I for ablation of thyroid remnants in order to obviate the severe complications associated with reoperation. From January 1977 to December 1995, 210 papillary or follicular thyroid carcinoma patients received subtotal thyroidectomy or lobectomy. After the operation, 46 of the 210 patients received 131I for remnant ablation. At doses of > or = 30 mCi 131I, 38 thyroid remnants were successfully ablated; 25 of 38 (65.8%) patients successfully ablated patients received 30 mCi 131I one-four times. Five patients expired during the follow-up period, including two follicular carcinoma patients who were misinterpreted as having benign lesions in the first operation. Patients in the overall failure versus success group for thyroid remnant ablation revealed increased age, histopathology of follicular carcinoma, higher postoperative 131I uptake in the neck bed, higher postoperative thyroglobulin levels, bigger tumor size, and higher mortality. In conclusion, repeated 30 mCi 131I treatments were adequate for most thyroid remnant ablations following subtotal thyroidectomy or lobectomy in well-differentiated thyroid cancer patients. Misinterpretation of follicular cancer as benign lesions and unresectable tumor comprised the main reasons for mortality.
对于分化型甲状腺癌患者，建议行全甲状腺切除术，以清除任何潜在的对侧残余癌组织，并便于通过放射性碘（131I）检测转移灶。不幸的是，再次手术后严重并发症的发生率为8 - 32%。目前，关于131I对这种分化型甲状腺癌保守手术治疗的消融效果仍没有足够的数据。本研究的主要目的是检查311I对甲状腺残余组织的消融效果，以避免与再次手术相关的严重并发症。1977年1月至1995年12月，210例乳头状或滤泡状甲状腺癌患者接受了甲状腺次全切除术或叶切除术。术后，210例患者中的46例接受了131I进行残余组织消融。在131I剂量≥30 mCi时，38个甲状腺残余组织成功消融；38例成功消融患者中的25例（65.8%）接受了30 mCi 131I一至四次。5例患者在随访期间死亡，其中包括2例滤泡状癌患者，他们在首次手术中被误诊为良性病变。甲状腺残余组织消融总体失败组与成功组的患者显示出年龄增加、滤泡状癌组织病理学、颈部床术后131I摄取较高、术后甲状腺球蛋白水平较高、肿瘤尺寸较大和死亡率较高。总之，对于分化型甲状腺癌患者，在甲状腺次全切除术或叶切除术后，重复30 mCi 131I治疗足以消融大多数甲状腺残余组织。将滤泡状癌误诊为良性病变以及肿瘤无法切除是死亡的主要原因。
