甲状腺髓样癌

目的探讨甲状腺髓样癌的诊断要点及临床治疗原则。方法对我院１９７６～１９９６年收治的８８例甲状腺髓样癌的临床资料进行回顾性分析。结果患者均以颈部肿块就诊，可伴发腹泻。病理证实淋巴结转移率７３２４％。散发型甲状腺髓样癌８６例，家族型甲状腺髓样癌２例。误诊率２３８６％（２１／８８）。治疗方法均以手术切除原发灶或合并颈淋巴结清除为主。术后随访局部广泛切除术的５，１０，１５年存活率分别为４５４５％，２５００％，１００％；合并行颈部淋巴清扫术的５，１０，１５年存活率分别为７２４１％，６３１６％，６６６７％。结论甲状腺髓样癌术前确诊困难，但有下列情况应考虑本病：不论甲状腺是否触及肿块，但有淋巴结肿大并伴有顽固性非炎性腹泻者；有家族史者；血清降钙素明显高于或低于正常者。作者主张不论是否触及肿大淋巴结，对甲状腺髓样癌均应行原发灶根治性切除加同侧颈部淋巴清扫术。

Medullary thyroid carcinoma

Objective To study the main points of diagnose and the principle of therapy for medullary thyroid carcinoma (MTC). Methods The clinical data of 88 cases of MTC, who admitted from 1976 to 1996 were retrospectively analysed. Results The initial syndrome in all of the patients was the cervical mass and diarrhea. The rate of lymph node matastasis was 73.24%. Sporadic type of MTC was found in 86 cases, and familial type in 2 cases. As a preoperative misdiagnosis rate was 23.86%(21/88). As a major therapeutic method was primary tumor resection or combined with cervical lymph node dissection was adopted. Those patients who underwent local extensive dissection, the survival rate of 5, 10, 15 years was 45.45%, 25.00%, 100%(1/1) respectively. The survival rate of 5, 10, 15 years in the patients combined cervival dissection(except 1 cases died of anther disease) was 72.41%, 63.16%, 66.67% respectively. Conclusions MTC is difficult to diagnosis before operation, but the following information can help the diagnosis: (1) cervical lymph node has been palpated, accompanied with refractory diarrhea but noinflammatory diarrhea, no matter whether the mass of thyroid is palpated or not; (2) more than one patient with MTC is found in a family; (3) the calcitonoin of serum is higher or lower in patients with MTC than that in normal person. Authors advocate that primary tumor resection plus cervical lymphadenectomy should be done for patients with MTC no matter whether the cervical lymph node is palpated or not.