散发性甲状腺髓样癌规范与非规范手术的效果观察

Comparison of Outcome of Standarized or Non-Standarized Operation in Treatment of Sporadic Medullary Thyroid Carcinoma

目的探讨规范与非规范手术治疗散发性甲状腺髓样癌的效果和预后。方法回顾性分析我院2000年1月至2013年3月期间收治的26例甲状腺髓样癌患者的临床资料。按手术方式分为非规范化手术组和规范化手术组(即双侧甲状腺全切除+淋巴结清扫术)。分析2组患者的术后生化治愈、喉返神经和甲状旁腺损伤情况。结果非规范化手术组和规范化手术组患者的1年生化治愈率比较,差异无统计学意义(84.21%比100%,χ2=1.249 4,P>0.05),1年复发率分别为15.79%和0,规范化手术组的5年生化治愈率明显高于非规范化手术组,差异有统计学意义(100%比16.67%,χ2=4.444 4,P<0.05),5年复发率分别为0和83.33%。2组术后喉返神经损伤率(χ2=0.070 8,P>0.05)及甲状旁腺功能低下发生率(χ2=2.722 7,P>0.05)比较差异均无统计学意义。结论散发性甲状腺髓样癌行规范化手术可提高5年生化治愈率,减少复发,且并未增加术后喉返神经和甲状旁腺的损伤率。

Objective To investigate the effect of surgery and influence of posttreatment with non-standardized and standardized operation by reviewing and analyzing the sporadic medullary thyroid carcinoma operation cases. Methods The clinical data of 26 patients with sporadic medullary thyroid carcinoma treated by surgery from January 2000 to March 2013 in this hospital were analyzed retrospectively. These patients were divided into non-standardized operation group and standardized operation group （total thyroidectomy with lymph node dissection） according to the operation models. The biochemical cure rate, the complication rates of recurrent laryngeal nerve injury and hypopara- thyroidism of these two groups were investigated and compared. Results The 1-year biochemical cure rate had no statistical difference between the non-standardized operation group and standardized operation group （84. 21% versus 100%,x^2=1. 249 4, P〉0. 05）, the 1-year recurrence rate was 15.79% and 0, respectively. The 5-year biochemical cure rate of the standardized operation group was significantly higher than that of the non-standardized operation group （100% versus 16.67%,x^2=4. 444 4, P〈0. 05）. The 5-year recurrence rate was 0 and 83.33%, respectively. However, there was no obvious difference between the two groups on the injury rate of recurrent laryngeal nerve （x^2=0. 070 8, P〉0. 05）, as well as the rate ofhypoparathyroidism （x^2=2. 722 7, P〉0. 05）. Conclusions Compared with the non-standardized model, the standardized operation model （total thyroidectomy with lymph node dissection） shows a higher cure rate and a lower recurrent rate, and it does not increase the complication rates of hypoparathyroidism and recurrent laryngeal nerve injury.