甲状腺髓样癌手术切除范围的研究  

A study on resection extent for medullary thyroid carcinoma

作　　者：史亚飞[1] 张颖超 樊友本 邓先兆 郭伯敏 伍波 康杰 杨净渝[3] Shi Yafei;Zhang Yingchao;Fan Youben;Deng Xianzhao;Guo Bomin;Wu Bo;Kang Jie;Yang Jingyu(Department of Thyroid and Parathyroid Surgery,Affiliated Hospital of Jining Medical College.Jining,Shandong Province 272000,China;Department of General Surgery,Thyroid and Parathyroid Center,Shanghai JiaoTong University Affiliated Sixth People′s Hospital,Shanghai 200233 China;Department of Breast and Thyroid Surgery,the First People′s Hospital of YunNan Province,Kunming 650032,China)

机构地区：[1]济宁医学院附属医院甲状腺外科,山东省272000 [2]上海市第六人民医院甲乳疝外科,上海交通大学甲状腺疾病诊治中心,200233 [3]云南省第一人民医院甲乳外科,昆明650032

出　　处：《中华普通外科杂志》2020年第11期856-861,共6页Chinese Journal of General Surgery

基　　金：上海交通大学优秀专病诊治中心基金(2014年4号);济宁医学院教师科研扶持基金(JYFC2019FKJ110)。

摘　　要：目的分析甲状腺髓样癌手术切除范围与预后的关系。方法回顾性分析上海市第六人民医院2017年1月至2020年3月期间诊治的39例甲状腺髓样癌患者的临床资料。结果39例患者中男13例,女26例,年龄26~72岁。术前基础降钙素均升高,21.5~20000 ng/L。肿瘤分期:Ⅰ期35.9%,Ⅱ期23.1%,Ⅲ期25.6%,Ⅳ期15.4%。中央区淋巴结转移比例53.8%(21/39);侧颈区淋巴结转移比例43.6%(17/39),与术前降钙素水平是否≥200ng/L相关。中位随访时间10个月,生化治愈率达66.7%,解剖治愈率33.3%;暂时性喉返神经麻痹、暂时性和永久性甲状旁腺功能低下分别为2.6%、23%、2.6%。无术后出血、感染、乳糜漏,无死亡病例。结论甲状腺髓样癌建议采用双侧甲状腺全切除术,至少单侧中央区淋巴结清扫,如术前影像学怀疑或降钙素水平≥200 ng/L,需要进行侧颈淋巴结清扫,可达到较高的完全生化治愈率。Objective To analyze the relationship between surgical resection range and prognosis of medullary thyroid carcinoma.Methods Clinical data of 39 patients with medullary thyroid carcinoma treated in Shanghai Sixth People′s Hospital from Jan 2017 to Mar 2020 were retrospectively analyzed.Results There were 13 males and 26 females,age ranging from 26 to 72 years old.Preoperative calcitonin levels increased from 21.5 to 20000 ng/L.Tumor stage:stageⅠwas 35.9%,stageⅡ23.1%,stageⅢ25.6%,stageⅣ15.4%.The proportion of lymph node metastasis in central region was 53.8%(21/39).The proportion of lateral cervical lymph node metastasis was 43.6%(17/39),which was statistically related with the preoperative calcitonin level≥200 ng/L.The median follow-up was 10 months,and the biochemical and anatomical cure rates were 66.7%and 33.3%respectively.Transient recurrent laryngeal nerve palsy,temporary and permanent hypothyroidism were 2.6%,23%and 2.6%,respectively.There was no postoperative hemorrhage,infection,lymphatic leak or death.Conclusions Bilateral total thyroidectomy,and at least ispilateral central lymph node dissection were advocated for patients with MTC.When preoperative calcitonin level≥200 ng/L,lateral cervical lymph node dissection is advised.

关 键 词：甲状腺肿瘤 癌 髓样 降钙素 淋巴转移 

分 类 号：R736.1[医药卫生—肿瘤]