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目的 研究基础水平降钙素与甲状腺髓样癌颈淋巴结转移规律及对治疗的作用。方法 自 1989年 5月至 1997年 10月对我院外科治疗的 48例甲状腺髓样癌进行基础水平降钙素检测 ,并分析其和手术范围的关系。结果 48例甲状腺髓样癌中 3 6例行甲状腺癌颈淋巴结清除术 ;8例行甲状腺癌局部广泛切除术 ;4例行患侧甲状腺叶加峡叶切除术。 48例甲状腺髓样癌中 ,基础水平降钙素正常者 2 0例 ,术后病理检查发现淋巴结阳性者 4例 ,淋巴结转移率为2 0 %。基础水平降钙素升高者 2 8例 ,术后病理检查淋巴结阳性者 2 7例 ,淋巴结转移率 96.4%。结论 基础水平降钙素与甲状腺髓样癌颈淋巴结转移呈正相关。升高时 ,应行颈淋巴结清除术。基础水平降钙素正常时临床上无颈淋巴结转移的病人 ,可暂行患侧甲状腺叶加峡叶切除 ,术后紧密随访 ,并予以基础水平降钙素监测。
Objective To study the basic level of calcitonin and medullary thyroid carcinoma cervical lymph node metastasis and the role of treatment. Methods From May 1989 to October 1997, 48 cases of thyroid medullary carcinoma with surgical treatment in our hospital were examined for basal level of calcitonin, and their relationship with the surgical range was analyzed. Results Thirty-six cases of thyroid medullary carcinoma were treated with thyroidectomy for cervical lymph nodes, eight cases were treated with extensive thyroidectomy, and four cases were treated by lobectomy. 48 cases of medullary thyroid carcinoma, basal level of normal calcitonin in 20 cases, postoperative pathological examination found in 4 cases of positive lymph nodes, lymph node metastasis rate was 20%. The basal level of calcitonin increased in 28 cases, postoperative pathological examination of lymph nodes in 27 cases, lymph node metastasis rate of 96.4%. Conclusions The basic level of calcitonin is positively correlated with cervical lymph node metastasis of medullary thyroid carcinoma. Ascending, cervical lymph node dissection should be performed. The basic level of normal calcitonin in clinical patients without cervical lymph node metastasis, may be temporarily affected by thyroidectomy with hypocotyl removal, follow-up after surgery, and basic level of calcitonin monitoring.