甲状腺髓样癌清扫纵隔淋巴结价值

The importance and value of mediastinal lymph node dissection in the treatment of medullary thyroid carcinoma

甲状腺髓样癌(MTC)是一种少见的神经内分泌肿瘤,约占全部甲状腺癌的1%~2%,其预后较差,早期即易发生颈淋巴结转移,少数(7.2%~26.6%)病人合并纵隔淋巴结转移(MLNM)。基础降钙素水平和颈胸CT、18F-DOPAPET-CT对MLNM的诊断具有参考价值。根据手术范围可选择颈部入路、胸骨劈开入路,甚至腔镜辅助手术,遵循整块切除的原则。MLNM根治性切除的病人可达生化缓解、有较好的预后,尤其对于无远处转移的病人。

Medullary thyroid carcinoma(MTC)is a rare neuroendocrine neoplasm and accounts for only 1%to 2%of all thyroid cancers,but its malignancy is relatively high and the prognosis is poor.It has been reported that cervical lymph node metastasis is common in MTC at the time of initial diagnosis.Mediastinal lymph node metastases(MLNM)will also occur lately(7.2%to 26.6%).Basal calcitonin level,enhanced cervical and thoracic CT and 18 F-DOPA PET-CT are more useful for the diagnosis of MLNM.According to the scope of surgery,transcervical approach,sternotomy,or even endoscopic-assisted surgery can be performed following with the principle of en bloc".Patients with radical mediastinal lymph node dissection have a good prognosis with biochemical cure,especially for those without distant metastasis.