Umdlavuza we-Thyroid yisifo sesithathu sokudla kabi kwezingane ezincane. Lo mdlavuza wezingane unokwabelana ngezici eziningana neziguli zomdlavuza wegciwane lesandulela ngculazi kubandakanya izigameko ezivamile ezihlanganisa ama-papillary, follicular and medullary; futhi owesifazane wesilisa ubukhulu bengu-6: 1, phakathi kwabanye.
Nakuba ukuhlala isikhathi eside komdlavuza wegciwane lesandulela ngculazi kuthiwa kuhle kakhulu, kuye kwaba nezifundo ezimbalwa ezikhomba imiphumela yemitholampilo yalesi sigameko esingumntwana.
Ucwaningo oluningi luye lwaluhlanganiswa nokubuyekezwa okukodwa. Ucwaningo oluningi lwezikhungo lwenzekile kodwa imizamo yokwakha i-database ekhudlwana ingalinganiselwe ukuhlelwa kwezikhungo noma zezifunda. Ukulinganiselwa kobukhulu besampula kulezi zifundo, kanye nesidingo sokulandela isikhathi eside sesifo ngesilinganiso esincane sokuphindaphindiwe, kuye kwabangela ubunzima ekuhloleni imiphumela emihle neyiphutha yokubikezela yokwelapha.
Ochwepheshe ababili be-otolaryngologist kanye nodokotela bezintamo bahlinzekela ukukhomba izimo eziguqukayo ezifana nokulandela izinombolo eziningi zeziguli esikhathini eside kufanele zihlaziywe ezigwema ukungcebeleka kwezikhungo nezifunda. Bahlola i-database enkulu kazwelonke eminyakeni engama-12 emzamweni wokuqonda kangcono imiphumela yesikhathi eside yomtholampilo yalolu daba, nakuba yizinye izikhathi ezibulalayo, izifo ezingeni likazwelonke emphakathini wabantwana. Ubude balezi zifundo zigweme ukuphazamiseka okufakwe kuloluhlobo locwaningo.
Abalobi beMiphumela-Population Based based for Pediatric Thyroid Carcinoma, nguNine L. Shapiro MD, Uhlu lweNhloko noMnyango Wezinyolo, UCLA School of Medicine, eLos Angeles, CA; kanye ne-Neil Bhattacharyya MD, e-Division of Otolaryngology, eBrigham kanye naseMinyangweni yeziNyango, noMnyango we-Otology neLaryngology, iHarvard Medical School, eCambridge, MA.
Ukuthola kwabo kuzokulethwa ngo-19 ngonyaka we-American American Society of Oedilaryngology we-Pediatric Otolaryngology http://www.aspo.us okuzoba ngoMeyi 2-3, 2004, ku-JW Marriott Desert Ridge Resort & Spa e-Phoenix, AZ.
Indlela yokuhlola: I-database ye-Surveillance, Epidemiology, kanye ne-End Results (SEER) (1988-2000) yabuyekezwa, isusa zonke iziguli zezingane ezine-carcinoma ye-thyroid ngokwemigomo elandelayo: (1) Ubudala ekuxilongweni kusukela ekuzalweni kuya eminyakeni engu-18; (2) Ukwandiswa okuyisisekelo kwe-tumor ebulalayo ye-thyroid; (3) I-carcinoma ye-thyroid ehlukaniswe kahle (i-papillary noma i-follicular) no (4) Unyaka wokuxilongwa phakathi kuka-1988 no-2000. Iziguli ezinezinye izinhlobo zesisu ezifana ne-plastiki noma i-medullary carcinoma azifakiwe. Idatha yezokwelapha kanye ne-tumor ekhishwe kwi-database ehlanganisa iminyaka yobudala ekuxilongweni, ubulili, i-histology yakhe yesisu, ubukhulu be-tumor, ubukhulu besifo se-site esiyinhloko, ubukhulu besifo se-nodal, ukwelashwa nokuhlinzwa kanye / noma iodine ye-radioactive, nezibalo zokusinda.
Idatha yethulwe futhi ingeniswe ku-SPSS version 10.0. Kusukela kokuguquguquka kwesifo, izinga lesifo esiyisisekelo senziwa njengoba kwabikwa ngaphambilini. Isifo se-Nodal sabhalwa njengobungakho noma ukungabikho kwamakhaza wesibeletho ngesikhathi sokuxilongwa.
Ubukhulu be-site oyinhloko yokwelashwa kwe-site kwahlukaniswa njenge-biopsy kuphela, i-lobectomy, i-thytectectomy ye-subtotal, noma i-thyroidectomy yakho yonke.
Imiphumela: Abacwaningi babhekisele ku-566 i-cardiomomia ye-thyroid yengane eminyakeni engu-12. Iminyaka yobudala ekukhulunywe ngayo yayineminyaka engu-16.0, kanti iziguli ezingama-84 ezingamaphesenti angu-84. Izinhlobo ze-tumor zazingama-378 (amaphesenti angu-66,8) ama-carcinomas amaphepha, 137 (amaphesenti angu-24,2) ama-carcinomas asemaphesenti ane-follicular variant, nama-51 (amaphesenti angu-9.0) ama-follicular carcinomas. Ngokuvamile, usayizi wesifo se-tumor ngesethulo sasingu-2.6 centimeters. Ngokuphathelene nesifo sesifo esiyinhloko, iningi leziguli (amaphesenti angu-74.2) lalinesifo sofuba esisodwa.
Iqembu elincani lalinesandiso esincane sendawo (amaphesenti angu-12.5), kanti bambalwa babenezandiso ezinkulu noma ezingaphezulu (amaphesenti angu-5.4). Izifo ezinama-nodal entanyeni entanyeni zazikhona ezingamaphesenti angu-37.1 ezigulane ekutholeni ukuxilongwa. Iningi leziguli lalashwa nge-thyroidectomy (amaphesenti angu-72,8) alandelwa yi-subtotal thyroidectomy (amaphesenti angu-13,4) alandelwa i-lobectomy elula (amaphesenti angu-7.2). Ukwelashwa kwe-iodine yomsakazo kwanikezwa amaphesenti angu-51.4 weziguli.
Ukusinda jikelele kweqembu lonke kwakunezinyanga ezingu-153.8, okulinganiselwe ezinyangeni ezingu-155 zokulandelwa okuphezulu. I-papillary carcinomas (ukusinda okushoyo, izinyanga eziyi-155.3) kwahamba kangcono kunama-carcinomas e-follicular Age of age, ukutholakala kwama-node ama-cervial amahle, ubukhulu bokuhlinza nokusetshenziswa kwe-iodine therapy ye-radioactive akuzange kuthinte kakhulu ukusinda jikelele. Ubulili besilisa, i-histology ye-follicular, kanye nokuhlasela kwesifo sokuqala kwendawo kwakunezimo eziphawuleka kakhulu ekunciphiseni ukusinda isikhathi eside.
Imiphumela ehambisana nokuthola okuvela kwezinye izifundo ezisho ukuthi umdlavuza wegciwane lesandulela ngculazi usuke uvame kakhulu eminyakeni eyishumi neminyaka, ikakhulukazi kwabesifazane. Uhlobo oluvamile kakhulu lwe-hertologic luyi-papillary, njengoba kubonakala kubantu abadala. Ukusatshalaliswa kwezifo ze-nodal (amaphesenti angu-37.1) kwakufana nalokho okubonwa ezincwadini zangaphambili. Lolu cwaningo luveze ukuthi ngenkathi ukwelashwa kwe-tumor oyinhloko kuvela ku-lobectomy elula ukuya ku-totalroidectomy, inani lokungenelela kokuhlinzwa alizange lithonye imiphumela yokuphila. Lokhu kuthoyana kuhluke emibhalweni eminingi ngaphambi kokuba ichaze imiphumela emihle kwiziguli ezithengiswa ngokuphindaphindiwe okunjenge-sub-total noma i-thyroidectomy yakho yonke. Isikhathi sokuxilongwa, isimo se-nodal, nokwengezwa kwe-iodine therapy ye-radioactive nakho kwakungekho ithonya elibalulekile ekusindeni. Ubulili besilisa, isandiso sesifo sokuqala samasayithi, kanye ne-follicular subtype bonke babenethonya elibi lokubikezela ekusindeni uma kuqhathaniswa nezinye iziguquko zesayithi. Iziphetho: I-carcinoma ye-thyroid yengane ibonisa imiphumela emihle kakhulu yokuphila isikhathi eside. Iziguli ezinezinhlobonhlobo ze-follicular zibonisa imiphumela embi kakhulu kunalabo abanezinhlobonhlobo ze-papillary. Nakuba lesi sifo sivame ngokwengeziwe kwabesifazane kunamadoda, abesilisa abane-carcinoma ye-thyroid banemiphumela embi kunabesifazane. Ukwandiswa kwesifo sesisifo samabanga aphansi esendaweni esendaweni esendaweni esendaweni yangasese futhi sinomthelela omubi kakhulu uma kuqhathaniswa nesifo se-intrathyroidal yedwa. Ngenkathi umsebenzi wokuhlaziya nokuphathwa kufanele ugxilwe ngesiguli ngasinye, kubhekwe ukulimala okuncane okumele kube khona okwesikhashana, lolu cwaningo olusha luhlinzeka ngolwazi lwamanje lokusindiswa kwezintando zeziguli ezine-carcinoma yegciwane lesandulela ngculazi ngokuqondene nokuphila kanye nezici zemitholampilo ezithinta umphumela.