降钙素对甲状腺髓样癌诊断和术式选择的意义  

Study on calcitonin in diagnosis and surgery selection in patients with medullary thyroid cancer

作　　者：宋宁宁[1,2] 王义增[1,3] 李欣[1,3] 刘媛超 王新超[2] 何向辉[3] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津医科大学第四中心临床学院甲状腺乳腺外科,天津300140 [3]天津医科大学总医院普通外科,天津300052

出　　处：《天津医科大学学报》2017年第3期239-241,共3页Journal of Tianjin Medical University

摘　　要：目的:研究降钙素对甲状腺髓样癌诊断价值和首次术式选择及预后的意义。方法:回顾性分析23例降钙素水平增高案例(甲状腺髓样癌14例,乳头状癌6例,结节性甲状腺肿2例,甲状旁腺瘤1例)的临床资料;另收集14例术前未行降钙素检测、术后诊断为甲状腺髓样癌的临床资料,比较降钙素检测对首次术式及预后的影响。结果:行降钙素检测的14例甲状腺髓样癌患者中,术中冰冻出现假阴性2例。同期淋巴结转移与淋巴结未转移相比降钙素水平明显增高。未行降钙素检测导致首次手术不规范而需追加二次手术有7例,病理示残癌率85.7%,颈部淋巴结转移占42.9%,1年内因复发再次手术有4例,高于降钙素检测首次术式规范者。结论:术前降钙素检测对术中冰冻在甲状腺髓样癌诊断上具有提示意义。首次规范术式能够避免近期追加二次手术,并降低复发发生率。Objective： To analyze value of calcitonin（Ctn） in diagnosis, operation selection and prognosis of thyroid medullary thyroid cancer（MTC）. Methods： Clinical data from 23 patients with increased Ctn amongthem, MTC 14 cases, 6 cases of papillary cancer,2 cases of nodular goiter, parathyroid adenoma 1 case were analyzed retrospectively. The data from 14 MTC patients without Ctn test were collected for comparing effect of Ctn test on surgery. Results： Two false negative cases by frozen section had an increased Ctn level in 14 MTC patients detected by Ctn. Ctn level was significantly higher in patients with lymph node metastasis than without. Seven patients without Ctn test received reoperation due to non-standard first operation and pathology confirmed 85.7% cases with residual tumor and 42.9% cases with lymph node metastasis, and 4 patients received reoperation due to recurrence within 1 year, more than patients who received standard first operation. Conclusion： The serum Ctn test may have implications on diagnosis of MTC by frozen section. Standard first operation can decrease rate of reoperation and recurrence.

关 键 词：甲状腺髓样癌 降钙素 术中冰冻 再次手术 

分 类 号：R653[医药卫生—外科学]