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目的 评价手术治疗甲状腺髓样癌的疗效和术后监测血清降钙素的意义。方法 回顾性分析 1992年 1月～ 1998年 12月的 14例甲状腺髓样癌的诊治资料。结果 全组均经病理证实为甲状腺髓样癌 ,6 4 3 %并颈淋巴结转移。据AJCC临床分期 ,Ⅰ期 1例 ,Ⅱ期 7例 ,Ⅲ期 5例 ,Ⅳ期 1例。术后监测血清降钙素的 9例中 4例持续增高 ,经B超扫描证实有残留甲状腺癌病灶和颈淋巴结肿大而再次手术治疗。再次术后 3例血清降钙素恢复正常 ,1例仍高于正常。首次术后随访 2～ 8年 ,死亡 2例 ,生存期超过 5年者 6例。结论 甲状腺髓样癌就诊时的临床分期是重要的预后因素 ,首次手术的彻底性是治愈甲状腺髓样癌的必要手段 ,术后监测血清降钙素有助于发现甲状腺髓样癌残留和复发
Objective To evaluate the efficacy of surgical treatment of medullary thyroid carcinoma and the significance of monitoring serum calcitonin after surgery. Methods A retrospective analysis of the diagnosis and treatment of 14 cases of medullary thyroid carcinoma from January 1992 to December 1998 was conducted. Results All patients were pathologically confirmed as medullary thyroid carcinoma, 634% with cervical lymph node metastasis. According to the clinical staging of AJCC, 1 case was in stage I, 7 cases in stage II, 5 cases in stage III, and 1 case in stage IV. Postoperative monitoring of serum calcitonin in 4 cases continued to increase in 4 cases, confirmed by B-scan with residual thyroid cancer lesions and neck lymph nodes and re-surgical treatment. Three cases of postoperative serum calcitonin returned to normal, and one case was still higher than normal. After the first postoperative follow-up of 2 to 8 years, 2 patients died and 6 patients survived more than 5 years. Conclusion The clinical stage of thyroid medullary carcinoma at the time of diagnosis is an important prognostic factor. The thoroughness of the first operation is a necessary means to cure medullary thyroid carcinoma. Postoperative monitoring of serum calcitonin helps to discover the residual and recurrence of medullary thyroid carcinoma.