甲状腺髓样癌临床诊疗方案分析

目的探讨影响甲状腺髓样癌(medullary thyroid carcinoma,MTC)治疗方案制订与转归的关键要素。方法回顾性分析2007年4月至2020年3月湖南省人民医院乳甲外科收治的23例MTC患者病例资料、典型病例的临床特点及生存随访结果,结合ATA等指南对MTC治疗方案和转归进行分析。结果23例MTC中,有22例(95.65%)术前血清降钙素(calcitonin,Ctn)不同程度的升高;15例(65.22%)术前癌胚抗原(carcinoembryonic antigen,CEA)不同程度的升高;3例(13.04%)术前超声及增强CT提示颈部有可疑异常淋巴结;2例(8.70%)术中探查可见包膜侵犯。23例中行患侧甲状腺腺叶切除术1例、患侧甲状腺腺叶切除术+患侧中央区淋巴结清扫术2例、甲状腺全切术3例、甲状腺全切术+患侧中央区淋巴结清扫术1例、甲状腺全切术+双侧中央区淋巴结清扫术13例、甲状腺全切术+双侧中央区淋巴结清扫术+单侧侧颈区淋巴结清扫术3例。8例(34.78%)术后出现复发,其中有7例为第一次手术不规范导致。2例术前Ctn明显升高,仅行甲状腺全切+双侧中央区淋巴结清扫术,术后未见复发。结论规范化的手术治疗是MTC生物治愈的关键,但也不能简单参照如Ctn等单一因素来决定手术方式,MTC现代治疗方案需同时遵循规范化原则及个体化原则来制定。

Clinical diagnosis and treatment plan of medullary thyroid carcinoma

Objective To explore the key factors affecting the formulation of treatment and prognosis of medullary thyroid carcinoma.Methods Patient data,clinical characteristics and the results of follow-up of typical cases of 23 patients with medullary thyroid carcinoma admitted to Hunan Provincial People's Hospital Breast and Thyroid Surgery from Apr.2007 to Mar.2020 were retrospectively analyzed.The therapeutic schedule and prognosis of medullary thyroid carcinoma were discussed in combination with ATA guidelines and others.Results Of the 23 patients with MTC,22(95.65%)had elevated serum calcitonin,15(65.22%)had elevated carcinoembryonic antigen,3(13.04%)had suspected abnormal lymph nodes,and 2(8.70%)had capsule invasion.Thyroid lobectomy,thyroid lobectomy with lateral lymph node dissection in level VI,total thyroidectomy,total thyroidectomy with lateral lymph node dissection in level VI,total thyroidectomy with bilateral lymph node dissection in level VI,total thyroidectomy with bilateral lymph node dissection in level Ⅵ with lymph node dissection in level Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴ or Ⅶ were performed in 1.2.3,1,13,3 cases respectively.8 cases had postoperative recurrence(34.78%),of which 7 cases were caused by the first operation.The level of Ctn increased significantly in 2 cases before operation,who underwent total thyroidectomy with bilateral lymph node dissection in level VI,and no recurrence was found after operation.Conclusions The key to the biological cure of medullary thyroid carcinoma is standardized surgical treatment.The surgery method cannot be determined simply by calcitonin.The modem treatment of medullary thyroid carcinoma needs to follow the principle of standardization and individualization at the same time.