2021来了，甲状腺癌应该这般治！
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">转眼<span style="color: black;">已经是</span>2020的尾声</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">过去的十年里</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲状腺癌发病率越来越高</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肿瘤治疗渐渐走向<span style="color: black;">精细</span>化</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲癌的治疗方式<span style="color: black;">亦</span><span style="color: black;">出现</span>了巨大变化</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-8cc5c2f6a7e019fd8b0621304c4414b0_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗手段是一步步丰富的</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">几百年前甲状腺手术就已开展</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">进入1930年，<span style="color: black;">起始</span><span style="color: black;">运用</span>TSH<span style="color: black;">控制</span>治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">到了1940年，碘131被用来处理转移灶</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2000年后，普通靶向<span style="color: black;">药品</span>被<span style="color: black;">研发</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2010年后，新技术<span style="color: black;">更加是</span><span style="color: black;">持续</span>涌现</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">比如基于基因突变的<span style="color: black;">精细</span>靶向<span style="color: black;">药品</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">例如</span>逆转不吸碘肿瘤的再分化技术</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">再<span style="color: black;">例如</span>免疫疗法和联用疗法</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">更<span style="color: black;">要紧</span>的是</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗理念<span style="color: black;">亦</span><span style="color: black;">出现</span>了巨大变更</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">初始治疗</h2>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-6e0b4419038e2a8c794614afcdc19687_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">经过几百年的发展</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲状腺手术技术<span style="color: black;">已然</span>非常成熟</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">变更的是手术理念</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">过去治疗以全切为主</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">此刻</span>会<span style="color: black;">按照</span>肿瘤类型和分布</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">分为观察，半切，和全切</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">认识到隐匿淋巴转移的低<span style="color: black;">危害</span>性后</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">淋巴结的清扫方式<span style="color: black;">亦</span><span style="color: black;">出现</span>了变化</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">预防性清扫<span style="color: black;">已然</span>较少<span style="color: black;">运用</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">取而代之的是有证据的治疗性清扫</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">不外</span>度清扫不等于随意摘 </p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当甲状腺，中央区，侧颈区存在可见病灶时</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">完整的切除清扫<span style="color: black;">非常</span><span style="color: black;">要紧</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">只是<span style="color: black;">再也不</span>追求<span style="color: black;">茫然</span>扩大手术范围</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">提倡的是切除肿瘤和功能<span style="color: black;">守护</span>的平衡</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">TSH<span style="color: black;">控制</span>治疗</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1930年后，甲状腺激素首次被<span style="color: black;">运用</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲癌的TSH<span style="color: black;">控制</span>治疗从此开启</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">起初<span style="color: black;">大众</span><span style="color: black;">亦</span>是觉得<span style="color: black;">控制</span>的越低越好</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">就像有的<span style="color: black;">大夫</span><span style="color: black;">需求</span>所有<span style="color: black;">病人</span>TSH<0.1<span style="color: black;">同样</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">然则</span>后来<span style="color: black;">发掘</span>过度<span style="color: black;">控制</span>的副<span style="color: black;">功效</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">乃至</span>远远高过甲癌本身</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic1.zhimg.com/80/v2-da614c50a860059dcdc5af3aba7f69a4_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">此刻</span>的TSH<span style="color: black;">控制</span><span style="color: black;">目的</span>更加精细化</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">术后两年内的<span style="color: black;">目的</span>取决于复发<span style="color: black;">危害</span>分级</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">两年后的<span style="color: black;">目的</span>取决于动态<span style="color: black;">危害</span>分层</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">经过</span>分级和分层</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">实现更好的个体化管理</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><a style="color: black;"><span style="color: black;"><span style="color: black;">TSH的<span style="color: black;">目的</span>范围</span><span style="color: black;"><span style="color: black;"></span>mp.weixin.qq.com/s?__biz=MzI1N</span></span></a>jUyMTM2Mw==&mid=2247485168&idx=1&sn=c0e144835b2ffe74a60c57e9aa412ec8&chksm=ea24230cdd53aa1aaeba1dcf8d88ca38417f58c35348e5bfdc1cd82c60c2fd634940e5946cfd&scene=21#wechat_redirect</div>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">碘治疗</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">1940年后，碘治疗被用于治疗转移灶</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">随后世界范围内碘治疗<span style="color: black;">运用</span>率达到巅峰</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2000年后，国内医院<span style="color: black;">起始</span><span style="color: black;">运用</span>碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">碘治疗次数<span style="color: black;">更加是</span>创了吉尼斯记录</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">8次，12次，14次，18次，<span style="color: black;">乃至</span>20次</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">近些年，<span style="color: black;">大众</span><span style="color: black;">认识</span>到<span style="color: black;">非常多</span>癌细胞不摄碘</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">以及大剂量碘治疗的副<span style="color: black;">功效</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">对碘131的<span style="color: black;">运用</span><span style="color: black;">亦</span>更加<span style="color: black;">小心</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">我<span style="color: black;">这儿</span><span style="color: black;">供给</span><span style="color: black;">有些</span>通用的规则</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>你的甲癌细胞局限于颈部</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">最多只喝一次碘</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>你的甲癌细胞有远处转移</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">第1</span>次碘治疗没看到效果</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">亦</span><span style="color: black;">没</span>需<span style="color: black;">更加多</span>治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>你有远处转移且癌细胞摄碘良好</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">一般</span>喝到三次碘后<span style="color: black;">亦</span>很难获益</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">再次手术</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">即便经历了甲状腺手术，碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">有些人还是会<span style="color: black;">显现</span>可疑的淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">过去针对这类淋巴结都是再手术</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">此刻</span>更提倡适度观察</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">一方面是<span style="color: black;">由于</span>即便多次手术后</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">非常多</span>时候肿瘤指标不会清零</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">另一方面是多次手术的<span style="color: black;">危害</span><span style="color: black;">常常</span>更高</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">可否</span>再次手术不取决于一颗淋巴结的好坏</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">而是权衡手术的收益和<span style="color: black;">危害</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这<span style="color: black;">亦</span>是<span style="color: black;">为何</span>2015版指南中</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">只<span style="color: black;">意见</span>处理中央区短边超过8毫米</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">侧颈区短边超过10毫米的可疑淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但8毫米，10毫米的分界线不是绝对的</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">还要结合<span style="color: black;">实质</span>病史和肿瘤标志物</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;"><span style="color: black;">药品</span>治疗</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尽管<span style="color: black;">以上</span>治疗对绝大<span style="color: black;">都数</span>人适用</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但很难抵抗<span style="color: black;">反常</span>凶猛的甲癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">为了战胜致命性甲状腺癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">新药<span style="color: black;">开发</span>拉开序幕</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2011年，<span style="color: black;">第1</span>款甲癌用药凡德他尼<span style="color: black;">获准</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个月，第十款甲癌用药普拉替尼<span style="color: black;">获准</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">十年，十款救命药</p><span style="color: black;">获准</span>年份药名针对类型特殊<span style="color: black;">需求</span>2011凡德他尼髓样癌_2012卡博替尼髓样癌_2013索拉非尼分化型甲癌_2015乐伐替尼分化型甲癌_2017帕博利珠单抗所有高度微卫星不稳定2018达拉非尼曲美替尼未分化癌BRAF突变2018拉罗替尼所有NTRK融合2019恩曲替尼所有NTRK融合2020塞尔帕替尼所有RET突变/融合2020普拉替尼所有RET突变/融合<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">有了这些可利用的新药</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲癌的<span style="color: black;">药品</span>治疗更<span style="color: black;">精细</span>化</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">BRAF突变的甲癌是一种给药<span style="color: black;">次序</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">RET融合的甲癌是另一种给药<span style="color: black;">次序</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">NTRK融合的甲癌又是一种给药<span style="color: black;">次序</span></p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">笔记总结</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2021就要到了</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲癌的治疗理念<span style="color: black;">已然</span><span style="color: black;">出现</span>了变化</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">再也不</span>追求一味的切切切，碘碘碘</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尽全力消灭每一个癌细胞（<span style="color: black;">实质</span><span style="color: black;">亦</span>不可能）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">而是<span style="color: black;">期盼</span>你活得更久，生活质量更高</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>有一天你离开这个世界</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">既不是<span style="color: black;">由于</span>甲癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">亦</span>不是<span style="color: black;">由于</span>甲癌治疗<span style="color: black;">引起</span>的副<span style="color: black;">功效</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">那样</span>治疗才算是成功的！</p>最后，欢迎关注最厉害的甲状腺<span style="color: black;">微X</span>公众号「温哥华小文青」。
你的见解真是独到，让我受益匪浅。 大势所趋，用于讽刺一些制作目的就是为了跟风玩梗，博取眼球的作品。 说得好啊！我在外链论坛打滚这么多年，所谓阅人无数，就算没有见过猪走路，也总明白猪肉是啥味道的。 我们有着相似的经历，你的感受我深有体会。
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