当青年人遭遇疯狂的甲状腺癌
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">大众</span>常说甲状腺癌是懒癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但<span style="color: black;">亦</span>不乏来势汹汹的<span style="color: black;">状况</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当看似凶猛的甲癌<span style="color: black;">出现</span>在<span style="color: black;">青年</span>人身上</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">怎样</span><span style="color: black;">恰当</span>地规划治疗<span style="color: black;">方法</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">今天给<span style="color: black;">大众</span>带来一个案例</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">案例<span style="color: black;">源自</span>：Dr. Sara Ahmadi</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">治疗之路</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">22岁女性因触摸到锁骨上肿物<span style="color: black;">看病</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">进一步超声<span style="color: black;">检测</span><span style="color: black;">发掘</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">左侧甲状腺5.4厘米的可疑结节</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">和左侧颈大面积可疑淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胸部CT<span style="color: black;">表示</span>弥散的肺结节</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">最大径约为5毫米</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">接下来的手术切除了<span style="color: black;">所有</span>甲状腺</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">清扫了中央区和左侧颈淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">术后病理提示5.2厘米经典型乳头状癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">原发肿瘤大面积腺外侵犯</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">清扫的83枚淋巴结中转移了30枚</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">最大淋巴结转移灶5.9厘米</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">术后<span style="color: black;">控制</span>状态下Tg高达43</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">紧接着接受了150毫居的碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">碘扫图像<span style="color: black;">表示</span>双肺和右侧颈淋巴结摄碘</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">碘治疗一年后<span style="color: black;">控制</span>性Tg下降到7.1</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">再次小剂量碘扫<span style="color: black;">无</span>转移灶吸收</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">随后进入<span style="color: black;">长时间</span>随访</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">治疗解析</h2>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">术前准备</h3>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-c0e05c1e8a5f835ee84165e4834c91a7_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;">超声<span style="color: black;">发掘</span>了左图5.4厘米的甲状腺囊实性肿物</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">黑色部分是囊性的液体</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">灰色部分是实性的肿瘤</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">图像提示腺外侵犯</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">右图是1.7厘米的左侧颈淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">短径超标且呈圆形性质可疑</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">基于上面的信息</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">她的<span style="color: black;">全部</span>甲状腺<span style="color: black;">没</span>法<span style="color: black;">保存</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中央区和左侧颈淋巴结<span style="color: black;">必须</span>清扫</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当<span style="color: black;">显现</span>了大范围淋巴结转移</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">必须</span>颈部<span style="color: black;">加强</span>CT<span style="color: black;">检测</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">防止漏掉位置特殊的转移淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">没</span>论是中央区可疑淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">还是侧颈区可疑淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">超声<span style="color: black;">一般</span>都能<span style="color: black;">发掘</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">少许</span>可疑淋巴结<span style="color: black;">由于</span>位置过低<span style="color: black;">或</span>过高</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">例如</span>上纵隔和咽旁淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">则<span style="color: black;">必须</span>CT来<span style="color: black;">弥补</span></p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">术后短期<span style="color: black;">评定</span></h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">颈部<span style="color: black;">加强</span>CT<span style="color: black;">无</span><span style="color: black;">发掘</span>位置特殊的可疑淋巴结</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">她<span style="color: black;">根据</span>原<span style="color: black;">方法</span>接受了手术</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">手术非常顺利</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">术后声音正常<span style="color: black;">亦</span><span style="color: black;">无</span><span style="color: black;">显现</span>缺钙<span style="color: black;">状况</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">下面是<span style="color: black;">最后</span>的病理报告</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-275aa3b286a32663468163998ede389f_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;">乳头状癌的病理<span style="color: black;">评定</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">重点</span>看腺外侵犯和淋巴结转移程度</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">她的报告提示大面积腺外侵犯</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">以及大面积淋巴结转移（转移灶最大径5.9厘米）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">就复发<span style="color: black;">危害</span><span style="color: black;">来讲</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">毫<span style="color: black;">没</span>疑问属于高危</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">术后六周Tg<span style="color: black;">控制</span>状态下高达43</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">复发<span style="color: black;">危害</span>分级又属于高危</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">此时</span>术前<span style="color: black;">发掘</span>的肺结节就非常可疑</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肺结节其实很<span style="color: black;">平常</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">它们大多和甲癌<span style="color: black;">没</span>关</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">病理分级和肿瘤标志物有助于性质的判断</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">首次碘治疗</h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">复发<span style="color: black;">危害</span>高危的乳头状癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肺部又高度<span style="color: black;">可疑</span>是转移</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">自然<span style="color: black;">必须</span>碘治疗辅助</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">她停药后Tg刺激状态下<span style="color: black;">提升</span>到272</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">小剂量碘扫<span style="color: black;">表示</span>肺部有摄取</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">于是接受了150毫居的治疗剂量</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic2.zhimg.com/80/v2-b282dbb404e92fd512b6bc2e0a3ae039_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;">非常多</span>人问碘扫是<span style="color: black;">显现</span>摄碘病灶好还是没<span style="color: black;">显现</span>好</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这个<span style="color: black;">不可</span>一概而论</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">针对这类<span style="color: black;">身体</span><span style="color: black;">知道</span>有病灶的<span style="color: black;">状况</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肯定是<span style="color: black;">期盼</span>病灶摄碘</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">并且吸收强度越高越好</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">她治疗后碘扫<span style="color: black;">表示</span>双肺和右侧颈淋巴结吸碘很好</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">预示碘治疗有效</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-46029062009cf128c28baf3ddd120e96_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;">碘治疗六个月后<span style="color: black;">控制</span>性Tg从43下降到12</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">十二个月后下降到7.1</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">胸部CT提示肺结节变小且数量减少</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">颈部超声<span style="color: black;">无</span>任何<span style="color: black;">反常</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">没</span>论是生化指标还是影像学结果</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">都证实了<span style="color: black;">第1</span>次碘治疗有效</p>
<h3 style="color: black; text-align: left; margin-bottom: 10px;">多次碘治疗</h3>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">即便<span style="color: black;">第1</span>次碘治疗取得了不错的效果</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">随着治疗次数的<span style="color: black;">增多</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">虽然可能还有效果</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">疗效是<span style="color: black;">逐步</span>变差的</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">另一</span>多次碘治疗让肺转移完全消失的可能性很小</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">喝下去的碘越多</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">副<span style="color: black;">功效</span><span style="color: black;">亦</span>会越越<span style="color: black;">显著</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">青年</span>人会<span style="color: black;">增多</span>第二癌症的<span style="color: black;">出现</span>率</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">肺部摄碘的<span style="color: black;">状况</span><span style="color: black;">乃至</span>不排除<span style="color: black;">引起</span>肺纤维化</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此</span><span style="color: black;">是不是</span>进行多次碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">必定</span>要<span style="color: black;">评定</span>利<span style="color: black;">坏处</span>关系</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这位<span style="color: black;">病人</span>在一年后接受了小剂量碘扫</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">无</span>任何转移灶摄取</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">提示二次碘治疗效果可能有限</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">于是暂时终止了碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">进入<span style="color: black;">长时间</span>随访的<span style="color: black;">周期</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当然不排除将来某个时间<span style="color: black;">必须</span>二碘的可能性</p>
<h2 style="color: black; text-align: left; margin-bottom: 10px;">治疗中的平衡</h2>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当<span style="color: black;">青年</span>人患上甲癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>肿瘤的负荷过大</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">尤其是<span style="color: black;">显现</span>了远处转移的时候</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗后不太可能达到临床治愈的状态</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">安德森肿瘤中心有一项统计</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">126位远处转移的分化型甲癌</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">达到<span style="color: black;">没</span>病<span style="color: black;">存活</span>的仅仅有9位</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">但<span style="color: black;">她们</span>的<span style="color: black;">存活</span>率非常高</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">即便<span style="color: black;">显现</span>远处转移</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">20年<span style="color: black;">存活</span>率<span style="color: black;">一般</span>超过80%</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">倘若</span>是未成年人<span style="color: black;">乃至</span>接近100%</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">特别有</span>可能到了一个时间点后</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲癌自己失去了增长的动力</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗的<span style="color: black;">重要</span>是平衡“<span style="color: black;">掌控</span>肿瘤”和“减少副<span style="color: black;">功效</span>”</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">就像今天的<span style="color: black;">病人</span><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;">倘若</span>针对肺部病灶连续进行碘治疗</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">反而可能降低她的<span style="color: black;">存活</span>年限</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">观察等待后再做决策</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">是甲癌治疗中非常<span style="color: black;">要紧</span>的理念</p>最后，欢迎关注最专业的甲状腺公众号「温哥华小文青」。
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