甲状腺癌术后复发的几率有多大？怎么样判断甲状腺癌有没复发或转移？
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/KBtxqFjVg6AgvqfxTKQ1aql4fRxicHCxpkb7nzowcC50bjGrt8aqSEv5TAvr9wzA0edUjSuKmSfjnicMvljm9FiaA/640?wx_fmt=jpeg&from=appmsg&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;"></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">甲状腺癌治疗后</span><span style="color: black;">有<span style="color: black;">无</span>复发或转移，这应该是甲状</span><span style="color: black;">腺癌<span style="color: black;">病人</span>最关心的问题之一。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">甲状腺癌术后复发的几率有多少</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">甲状腺癌中最<span style="color: black;">平常</span>的类型是甲状腺乳头癌，占甲状腺癌总体的</span><span style="color: black;">90%</span><span style="color: black;">以上，预后很好，</span><span style="color: black;">10</span><span style="color: black;">年<span style="color: black;">存活</span>率在</span><span style="color: black;">90%</span><span style="color: black;">以上。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">虽然最<span style="color: black;">平常</span>的<strong style="color: blue;">甲状腺乳头状癌<span style="color: black;">病人</span>的<span style="color: black;">长时间</span>预后良好，但<span style="color: black;">亦</span>有<span style="color: black;">必定</span>的复发率</strong>，国外不同<span style="color: black;">科研</span><span style="color: black;">报告</span>，其</span><strong style="color: blue;"><span style="color: black;"><span style="color: black;">复发率在</span><span style="color: black;">10%~30%</span><span style="color: black;">之间</span></span></strong><span style="color: black;">，随着治疗水平的<span style="color: black;">提高</span>，总体复发率有下降趋势。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">相比较而言，<strong style="color: blue;">甲状腺髓样癌和未分化癌的复发率和转移率更高<span style="color: black;">有些</span></strong>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">甲状腺癌的复发率与分期、病理类型、分化程度和有<span style="color: black;">无</span><span style="color: black;">即时</span>接受规范的治疗等<span style="color: black;">原因</span><span style="color: black;">相关</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">通常</span><span style="color: black;">来讲</span>，分期越早，复发率越低，分期越晚，则复发率较高。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/KBtxqFjVg6BibOeFKkUm3Rz2Q4hr1JOtXxSpfFaJbrZ0XICFuxjmOtxEBxusIax7Gwj5hUpGZjDMBCRkZtRnMBw/640?wx_fmt=webp&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">怎样</span>判断甲状腺癌有<span style="color: black;">无</span>复发或转移</strong></p><strong style="color: blue;">1</strong><strong style="color: blue;">临床表现</strong>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">首要</span>，<span style="color: black;">能够</span><span style="color: black;">经过</span><span style="color: black;">病人</span>的临床表</span><span style="color: black;">现进行粗略判断</span><span style="color: black;">，</span><span style="color: black;"><span style="color: black;">针对</span><span style="color: black;">有些</span><strong style="color: blue;">易触及的、<span style="color: black;">很强</span>的或有症状的病灶</strong>，可初步<span style="color: black;">评定</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">如<span style="color: black;">病人</span>颈部<span style="color: black;">显现</span><span style="color: black;">显著</span>的淋巴结肿大，结合可疑的性状，<span style="color: black;">思虑</span>可能存在颈部淋巴结复发或转移，</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">或</span><strong style="color: blue;">存在<span style="color: black;">连续</span>加重的刺激性咳嗽、咳血、<span style="color: black;">呼气</span>困难、吞咽困难、骨痛、肝区<span style="color: black;">病痛</span>、头痛等症状</strong>，要<span style="color: black;">可疑</span><span style="color: black;">是不是</span>存在<span style="color: black;">关联</span>部位的复发或转移，<span style="color: black;">能够</span>对<span style="color: black;">显现</span>不适的部位进行重点排查。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">但仅<span style="color: black;">按照</span>临床表现<span style="color: black;">针对</span>隐蔽部位、病灶小<span style="color: black;">没</span>任何症状的复发灶或转移灶<span style="color: black;">评定</span>不足，<span style="color: black;">必须</span>借助<span style="color: black;">有些</span>其他<span style="color: black;">检测</span>来综合判断。</span></p><strong style="color: blue;">2</strong><strong style="color: blue;">影像学<span style="color: black;">检测</span></strong>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">若想<span style="color: black;">知道</span>甲状腺癌<span style="color: black;">是不是</span><span style="color: black;">出现</span>转移，<span style="color: black;">必须</span>借助影像学<span style="color: black;">检测</span>。常用的影像学<span style="color: black;">检测</span><span style="color: black;">办法</span><span style="color: black;">包含</span>：彩超、</span><span style="color: black;">CT</span><span style="color: black;">、碘扫描、</span><span style="color: black;">PET/CT</span><span style="color: black;">等等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">●</span><span style="color: black;"><strong style="color: blue;"><span style="color: black;">彩超（必要时结合造影或弹性超声）</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">颈部彩超<span style="color: black;">重点</span>是<span style="color: black;">检测</span>甲状腺部位和双侧颈部淋巴结<span style="color: black;">状况</span>，判断有<span style="color: black;">无</span><span style="color: black;">显现</span>淋巴结转移或甲状腺区有<span style="color: black;">无</span>复发等。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">倘若</span>颈部彩超<span style="color: black;">发掘</span><span style="color: black;">反常</span>，则<span style="color: black;">必须</span>进一步<span style="color: black;">评定</span>，必要时穿刺活检。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">重视</span>：</span></strong></span><span style="color: black;">如有颈部淋巴结肿大，<span style="color: black;">亦</span>不要<span style="color: black;">茫然</span>认为<span style="color: black;">便是</span>转移，<span style="color: black;">必须</span>结合临床<span style="color: black;">状况</span>，要排除淋巴结炎或反应性增生等<span style="color: black;">状况</span>，<span style="color: black;">按照</span>其特征可判断。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><a style="color: black;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/KBtxqFjVg6AqQGzx9rM7ZxviaiburyGzeCriaIdDkSApD9YJtoryguxGwKicxRCvTKFmukfxicqqnp0MTTT9EaG5ibKA/640?wx_fmt=jpeg&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">●</span><strong style="color: blue;"><span style="color: black;"><span style="color: black;">加强</span><span style="color: black;">CT</span>（或磁共振、<span style="color: black;">ECT</span>、<span style="color: black;">PET-CT</span>）</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">针对</span><span style="color: black;">有些</span>深在部位或彩超探查不到的区域，可采用。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">如颈部</span><span style="color: black;">CT</span><span style="color: black;">判断气管有<span style="color: black;">没</span>受侵犯，胸部</span><span style="color: black;">CT</span><span style="color: black;">判断胸部的结构，如纵膈或肺部有<span style="color: black;">没</span>转移，头部</span><span style="color: black;">CT</span><span style="color: black;">判断咽后区有<span style="color: black;">没</span>转移等等。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">核磁共振<span style="color: black;">检测</span>（</span><span style="color: black;">MRI</span><span style="color: black;">），<span style="color: black;">帮助</span>判断<span style="color: black;">是不是</span>有<span style="color: black;">要紧</span>器官转移，而全身骨</span><span style="color: black;">ECT</span><span style="color: black;">扫描<span style="color: black;">能够</span><span style="color: black;">帮助</span>判断有<span style="color: black;">没</span>骨转移等。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">●</span><strong style="color: blue;"><span style="color: black;">诊断性碘扫描</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">即<span style="color: black;">吃下</span>小剂量的碘</span><span style="color: black;">131</span><span style="color: black;">（</span><span style="color: black;">3-5mci</span><span style="color: black;">）后，在</span><span style="color: black;">48</span><span style="color: black;">小时</span><span style="color: black;">-72</span><span style="color: black;">小时进行全身</span><span style="color: black;">ECT</span><span style="color: black;">扫描，可<span style="color: black;">帮助</span>判断手术或碘</span><span style="color: black;">131</span><span style="color: black;">治疗后<span style="color: black;">是不是</span>存在残留甲状腺组织或病灶。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">倘若</span><span style="color: black;">显现</span>局部放射性浓聚灶，<span style="color: black;">能够</span>再进一步行全身的</span><span style="color: black;">PET-CT</span><span style="color: black;">扫描<span style="color: black;">发掘</span>散在的转移病灶。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">●</span><strong style="color: blue;"><span style="color: black;">PET-CT</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">PET-CT</span><span style="color: black;"><span style="color: black;">针对</span>判断术后有<span style="color: black;">没</span>残留、复发或转移<span style="color: black;">亦</span>有很大的<span style="color: black;">帮忙</span>。<span style="color: black;">最后</span>可结合病理<span style="color: black;">检测</span>进一步<span style="color: black;">知道</span>。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">●</span><strong style="color: blue;"><span style="color: black;">实验室<span style="color: black;">检测</span>（血液<span style="color: black;">检测</span>指标）</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">甲状腺球蛋白（</span><span style="color: black;">Tg</span><span style="color: black;">）</span></span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">分化型甲状腺癌经过甲状腺全切除或</span><span style="color: black;">/</span><span style="color: black;">和碘</span><span style="color: black;">131</span><span style="color: black;">治疗后，血清中的</span><span style="color: black;">Tg</span><span style="color: black;">含量很低，<span style="color: black;">针对</span>碘</span><span style="color: black;">131</span><span style="color: black;">清甲治疗后的甲癌<span style="color: black;">病人</span>的</span><span style="color: black;">Tg</span><span style="color: black;">几乎测不到。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">因此</span>，在甲状腺球蛋白抗体（</span><span style="color: black;">TgAb</span><span style="color: black;">）阴性的<span style="color: black;">状况</span>下，</span><span style="color: black;">Tg</span><span style="color: black;"><span style="color: black;">做为</span>分化型甲状腺癌复查的一个<span style="color: black;">要紧</span>指标，<span style="color: black;">能够</span><span style="color: black;">帮助</span>判断<span style="color: black;">是不是</span>复发或转移。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;"><span style="color: black;">针对</span></span><span style="color: black;">Tg</span><span style="color: black;">作为判断<span style="color: black;">是不是</span>复发的参考指标，有以下几种<span style="color: black;">状况</span>：</span></span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">A.<span style="color: black;">接受甲状腺全切除或</span><span style="color: black;">/</span><span style="color: black;">和碘</span><span style="color: black;">131</span><span style="color: black;">治疗的分化型甲状腺癌<span style="color: black;">病人</span>，在治疗后可<span style="color: black;">长时间</span>复查</span><span style="color: black;">Tg</span><span style="color: black;">，<span style="color: black;">倘若</span></span><span style="color: black;">Tg</span><span style="color: black;"><span style="color: black;">始终</span>保持稳定的低值，没<span style="color: black;">显现</span>很大幅度的<span style="color: black;">上升</span>，<span style="color: black;">通常</span><span style="color: black;">思虑</span>病情<span style="color: black;">安稳</span>。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">B.<span style="color: black;"><span style="color: black;">倘若</span>在复查过程中，<span style="color: black;">发掘</span></span><span style="color: black;">Tg</span><span style="color: black;">较前<span style="color: black;">升高</span>，但幅度不大，则<span style="color: black;">必须</span>关注<span style="color: black;">是不是</span>在按时按量服药优甲乐，将</span><span style="color: black;">TSH</span><span style="color: black;">值<span style="color: black;">掌控</span>到允许范围后，一到两个月后再次复查</span><span style="color: black;">Tg</span><span style="color: black;">。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">C.<span style="color: black;">倘若</span>还在<span style="color: black;">连续</span><span style="color: black;">上升</span>，则有可能存在复发或转移，此时，<span style="color: black;">必须</span>进结合临床，进一步排查有<span style="color: black;">没</span>复发或转移，可行<span style="color: black;">以上</span>影像学<span style="color: black;">检测</span><span style="color: black;">帮助</span><span style="color: black;">评定</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">D. </span><span style="color: black;">值得<span style="color: black;">重视</span>的是，当甲状腺球蛋白抗体（</span><span style="color: black;">TgAb</span><span style="color: black;">）阳性时，</span><span style="color: black;">TgAb</span><span style="color: black;">可能会影响</span><span style="color: black;">Tg</span><span style="color: black;">的值，<span style="color: black;">此时</span> </span><span style="color: black;">Tg</span><span style="color: black;"><span style="color: black;">帮助</span><span style="color: black;">评定</span>的<span style="color: black;">功效</span>就不大了。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">●</span><strong style="color: blue;"><span style="color: black;">降钙素和癌胚抗原</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">这两项指标<span style="color: black;">针对</span>判断甲状腺髓样癌<span style="color: black;">是不是</span>复发或转移有<span style="color: black;">要紧</span><span style="color: black;">道理</span>。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">倘若</span><span style="color: black;">病人</span>在复查过程中，<span style="color: black;">发掘</span>降钙素和癌胚抗原在<span style="color: black;">连续</span><span style="color: black;">上升</span>，则有可能存在复发或转移，此时<span style="color: black;">必须</span>结合临床，行<span style="color: black;">关联</span>影像学<span style="color: black;">检测</span><span style="color: black;">帮助</span>排查有<span style="color: black;">没</span>复发或转移。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">●</span><strong style="color: blue;"><span style="color: black;">病理<span style="color: black;">检测</span>确认</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">判断甲状腺癌<span style="color: black;">是不是</span>存在复发或转移，<span style="color: black;">日前</span>的金标准是病理学<span style="color: black;">检测</span>结果，即<span style="color: black;">按照</span>活检或切除的病理组织进行病理学检测。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">倘若</span><span style="color: black;">发掘</span>相应的肿瘤细胞，则可证明甲状腺癌<span style="color: black;">已然</span><span style="color: black;">出现</span>复发或转移。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">当然有些部位能够取到病理组织，可进行病理学<span style="color: black;">检测</span>，但有些部位难以取到病变组织，则要结合临床和其它<span style="color: black;">检测</span>手段<span style="color: black;">一块</span><span style="color: black;">评定</span><span style="color: black;">是不是</span>存在复发或转移。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">以上几种<span style="color: black;">检测</span><span style="color: black;">办法</span>，在甲状腺的随访中较常用到。当然，并不是所有的<span style="color: black;">检测</span>都<span style="color: black;">必须</span>做，不同病情不同对待，<span style="color: black;">大夫</span>会<span style="color: black;">按照</span>您的<span style="color: black;">状况</span><span style="color: black;">选取</span><span style="color: black;">必须</span>做的项目进行判断。</span><span style="color: black;">（</span><span style="color: black;">如有疑问，您可点击下方<strong style="color: blue;"><span style="color: black;">阅读原文</span></strong>在线进行咨询，<span style="color: black;">咱们</span>将耐心为您答疑解惑</span><span style="color: black;">）</span></p><strong style="color: blue;">END</strong>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">KE SHI JIAN JIE</p><img src="https://mmbiz.qpic.cn/mmbiz_png/KBtxqFjVg6Co2G2oCk5zTEAA8xftDaVWGfibaJvLcPdrscVWFzB37alSRDCkqQak6gBSyIecEk82yzjSuj4PmkQ/640?wx_fmt=png&wxfrom=5&wx_lazy=1&wx_co=1&tp=webp" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">甲乳外科是陕西冶金医院重点建设学科，以甲状腺和乳腺<span style="color: black;">疾患</span>为重点诊疗项目，学科技术力量<span style="color: black;">浑厚</span>，诊疗技术先进，仪器设备精良，<span style="color: black;">保持</span>以最小的创伤治愈甲乳<span style="color: black;">疾患</span>，最大限度的<span style="color: black;">保存</span>腺体功能，<span style="color: black;">创立</span>“保腺、融结、系统<span style="color: black;">恢复</span>”的治疗理念，打造甲乳<span style="color: black;">疾患</span>中西医结合一站式诊疗服务。</span></p>
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