儿童甲状腺肿瘤的临床特征及诊治体会

Clinical features and experience of diagnosis and treatment of thyroid neoplasm in children

摘要:

目的：探讨儿童甲状腺肿瘤的临床特征及诊断与治疗。方法：回顾性分析2002年1月至2010年12月中南大学湘雅医院经手术治疗的32例甲状腺肿瘤患儿的临床资料。结果：32例患儿中，女性23例，男性9例。经病理证实良性肿瘤6例，恶性26例。良性病例均诊断为腺瘤性结节性甲状腺肿，恶性均为甲状腺乳头状癌。B超对甲状腺恶性肿瘤的诊断率高达100%。14例患儿合并桥本氏甲状腺炎（44%）。22例患儿伴有同侧颈淋巴结转移（69%）。年龄在10岁以下者发生颈部淋巴结转移的比例较10岁以上者高（94% vs 56%，P＜0.05）。32例患儿均接受手术治疗。对6例良性病变患儿实施肿块侧腺叶次全切除术；对26例恶性病变患儿根据肿瘤不同进展阶段实施双侧甲状腺全切（17例）或患侧甲状腺全切（9例）。经随访3个月至9年，无复发、死亡病例，患儿生长发育正常。结论：儿童甲状腺肿瘤女性多见，恶性病变比例高；常合并桥本氏甲状腺炎；年龄在10岁以下者易发生局部淋巴结转移。手术是治疗甲状腺肿瘤的有效方法。

Abstract:

OBJECTIVE: To study the clinical features, diagnosis and therapy of thyroid neoplasm in children. METHODS: A retrospective study was performed on 32 children with thyroid nodular who were underwent operation in Xiangya Hospital between January 2002 and December 2010. RESULTS: Of the 32 cases, there were 23 girls and 9 boys. Six cases were diagnosed as nodular Goiter adenoma and 26 cases were diagnosed as thyroid papillary carcinoma. B-ultrasonic examination showed a 100% accurate rate for the diagnosis of thyroid carcinoma. Fourteen children (44%) were proven to have concurrent Hashimoto′s thyroiditis. Twenty-two (69%) children with thyroid carcinoma were found to have lymph metastasis in the lateral neck. The children younger than 10 years showed a high rate of metastasis than those older one (94% vs 56%, P＜0.05). All 32 children received a surgical therapy. Subtotal thyroidectomy was performed on the 6 children with nodular Goiter adenoma. Total thyroidectomy (17 cases) or ipsilateral thyroidectomy (9 cases) was performed according to the stage of thyroid carcinoma. The surgical outcomes were followed up for 3 months to 9 years and no recurrence or death occurred. The development and growth were normal in the children. CONCLUSIONS: Childhood thyroid nodular attacks girls more than boys, and the frequency of malignancy is high. Hashimoto′s thyroiditis is a common concurrent disease. The incidence of local lymph metastasis is high in those younger than 10 years. The surgical therapy for thyroid neoplasm may lead satisfactory outcomes in children.