9例甲状腺髓样癌的临床诊断与治疗

Clinical Diagnosis and Treatment of 9 Cases of Medullary Thyroid Carcinoma

目的探讨甲状腺髓样癌(medullary thyroid carcinoma,MTC)的临床诊断与治疗。方法回顾分析2005年1月至2011年1月南京医科大学附属南京第一医院收治的9例MTC的临床资料。结果 9例患者都以颈部肿块就诊,手术以甲状腺叶全切除+中央区淋巴结清扫术为主,总的淋巴结转移率为44.44%。术后均口服左甲状腺素片,随访5年以上3例,术后复发2例。结论甲状腺髓样癌术前确诊困难,血清降钙素可作为术前诊断最重要的指标。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 discuss the clinical diagnosis and treatment of medullary carcinoma of thyroid.Methods The clinical data of 9 cases of MTC from Nanjing First Hospital affiliated to Nanjing Medical University was retrospectively analyzed.Results The clinical manifestations in most patients with MTC were the cervical mass.Total thyroidectomy and cervical lymph node dissection were performed in all patients.The lymph node metastasis rate was 44.44%.The patient take L-thyroxine after the surgery.In 3 cases who were followed up for 5 years,2 cases of recurrent.Conclusion MTC was difficult to be diagnosed preoperatively.Serum calcitonin preoperative diagnosis can be used as the most important indexAn aggressive surgical approach at the initial operation is essential to achieve a curative effect in patient with MTC.Measuring plasma calcitonin postoperatively helps to detect residuled MTC or recurrent MTC.