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目的甲状腺全切术联合中央区颈淋巴结清扫术是甲状腺髓样癌外科治疗的基本术式。其临床疗效与预后因素被广泛研究,但预后因素仍然存在争议。本文对接受外科手术治疗的33例甲状腺髓样癌病例作一回顾性分析,以探讨和研究其临床疗效和预后因素。方法收集1995年1月~2010年12月就诊于我院并接受外科手术治疗的甲状腺髓样癌患者33例,其中接受甲状腺全切术/甲状腺次全切除术+中央区颈淋巴结清扫术(VI区)+单侧改良性侧颈淋巴结清扫术(II-V区)24例,接受甲状腺全切术/甲状腺次全切除术+中央区颈淋巴结清扫术(VI区)+双侧改良性侧颈淋巴结清扫术(II-V区)9例,术后常规行基础血清降钙素和激发后血清降钙素水平测定,激发后血清降钙素无法测到被认为生化治愈。术后随访时间60.0~130.0个月。以年龄、性别、瘤体大小、颈淋巴结转移、TNM分期、手术切除范围、术后放疗和化疗均作为预后相关因素给予分析。结果 33例接受外科手术治疗的甲状腺癌患者中,其中17例患者肿瘤直径>4.0 cm(51.5%),TNM分期属于Ⅳ期患者18例(54.5%)。23例患者达到生化治愈(69.7%),19例患者出现颈淋巴结转移(57.6%)。患者5年生存率与10年生存率分别是73.4%和19.6%。患者的生化治愈率与患者瘤体腺体外侵袭(P<0.005)、肿瘤大小(P<0.005)和颈淋巴结转移(P<0.0001)有显著的相关性。单因素分析显示年龄和颈淋巴结转移是预后相关因素。结论甲状腺髓样癌患者通过规范彻底的外科手术治疗绝大多数患者都能够获得长期无病生存,早期诊断和规范的颈淋巴结清扫术对于患者获得生化治愈是有益的,但无法保证疾病的决定性治愈。年龄和出现颈淋巴结转移是甲状腺髓样癌的预后相关因素,而年龄<45岁则是预后良好因素,年龄是唯一的独立预后因素。
Objective Thyroidectomy combined with central lymph node dissection is the basic surgical treatment of medullary thyroid carcinoma. Its clinical efficacy and prognostic factors are widely studied, but prognostic factors remain controversial. In this paper, a retrospective analysis of 33 cases of thyroid medullary carcinoma treated by surgical treatment to explore and study its clinical efficacy and prognostic factors. Methods Thirty-three patients with thyroid medullary carcinoma who were treated in our hospital from January 1995 to December 2010 were enrolled in this study. Thyroid gland total thyroidectomy / subtotal thyroidectomy + central lymph node dissection (VI Twenty-four patients underwent unilateral modified lateral neck lymph node dissection (II-V zone) underwent total thyroidectomy / subtotal thyroidectomy + central lymph node dissection (zone VI) + bilateral modified lateral neck Lymphadenectomy (II-V area) in 9 cases, routine postoperative routine serum basal serum calcitonin and serum calcitonin levels after the test, serum calcitonin can not be measured after being considered biochemical cure. Postoperative follow-up time 60.0 ~ 130.0 months. Age, gender, tumor size, cervical lymph node metastasis, TNM staging, surgical resection range, postoperative radiotherapy and chemotherapy were given as prognostic factors. Results Of the 33 thyroid cancer patients undergoing surgical treatment, 17 had a tumor diameter> 4.0 cm (51.5%), and TNM stage was in 18 patients (54.5%) with stage Ⅳ disease. Twenty-three patients achieved biochemical cure (69.7%), and 19 patients had cervical lymph node metastasis (57.6%). The 5-year survival rate and 10-year survival rate of patients were 73.4% and 19.6% respectively. The biochemical cure rate was significantly associated with extracorporeal invasion (P <0.005), tumor size (P <0.005), and cervical lymph node metastasis (P <0.0001) in patients. Univariate analysis showed that age and cervical lymph node metastasis were prognostic factors. CONCLUSIONS: Most patients with medullary thyroid carcinoma have long-term, disease-free survival through standardized radical surgical procedures. Early diagnosis and standard cervical lymph node dissection are beneficial for patients to obtain biochemical cure but can not guarantee the decisive cure of the disease . Age and presence of cervical lymph node metastasis are prognostic factors in medullary thyroid carcinoma, whereas age <45 years is a good prognostic factor and age is the only independent prognostic factor.