Wu Xiaojuan,Yi Bin,Wang Xiaolin,et al.Diagnosis and treatment strategies for thyroglossal duct cyst plus papillary thyroid carcinoma[J].Journal of Clinical Pediatric Surgery,2020,19(05):451-454.[doi:10.3969/j.issn.1671-6353.2020.05.015]
甲状舌管囊肿合并甲状腺乳头状癌的诊断与治疗
- Title:
- Diagnosis and treatment strategies for thyroglossal duct cyst plus papillary thyroid carcinoma
- Keywords:
- Thyroglossal Cyst; Carcinoma; Papillary; Thyroid Gland; Thyroidectomy; Child
- 分类号:
- R726;R581;R730.261
- 摘要:
- 目的 对甲状舌管囊肿合并甲状腺乳头状癌患儿的临床资料进行分析，总结此类少见疾病的诊断及处理方式。方法 2013年1月至2017年2月华中科技大学同济医学院附属同济医院共收治3例甲状舌管囊肿合并甲状腺乳头状癌患者，均为女性，年龄分别为27岁（患者1）、53岁（患者2）、9岁（患者3），均以颈部或颏下囊实性包块为主要症状就诊。其中1例在术前通过细针穿刺诊断为甲状腺乳头状癌，经术中冰冻切片再次确诊，行双侧甲状腺全切术；其他2例首次手术仅行包块切除，术后病理检查结果提示恶性病变，分别行双侧甲状腺切除和（或）双侧淋巴结清扫术。术后行131I治疗。结果 3例均顺利完成一次或多次手术，术中无输血，术后7天内出院。患者1及患者2分别随访5年、4年，随访期间无症状存活，无复发；通过甲状腺素的补充，甲状腺激素水平正常。患者3术后2个月出现肺部多发小结节，不排除转移，后行131I治疗，3个月后复查无明显病灶。结论 甲状舌管囊肿合并甲状腺乳头状癌患者行甲状腺全切术效果理想，术后131I治疗可减少复发，补充外源性甲状腺素可维持激素水平及儿童患者的生长发育。
- Abstract:
- Objective To analyze the clinical profiles of thyroglossal duct cyst with thyroid papillary carcinoma and explore the diagnostics and therapeutics of this rare disease.Methods Three girls were aged 27,53 and 9 years respectively.The major symptoms were cervical or submental cystic mass.One patient was diagnosed preoperatively as papillary thyroid cancer by fine needle puncture and bilateral total thyroidectomy was performed after a confirmation of intraoperative frozen section.Another two patients underwent mass resection alone initially.Postoperative pathological examination revealed malignant lesions and bilateral thyroidectomy and/or bilateral lymphadenectomy were performed.Postoperative treatment of iodine 131I was offered.Results All operations were completed successfully without blood transfusion.All children were discharged within 7 days post-operation.Children 1 and 2 survived asymptomatically for 5 and 4 years without recurrence.Thyroxine supplementation normalized the levels of thyroid hormone.Patient 3 had multiple pulmonary nodules in 2 months after operation.After a treatment of 131I,no obvious lesions were found within 3 months.Conclusion Bilateral total thyroidectomy is effective for children with thyroglossal duct cyst with thyroid papillary carcinoma.Postoperative 131I therapy reduces recurrence.Supplementation of exogenous thyroxine may maintain hormone levels and promote the growth and development.
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备注/Memo
收稿日期:2018-11-08。
基金项目:国家自然科学青年基金（编号：81500395）
通讯作者:冯杰雄,Email:fengjiexiong@126.com