基础水平降钙素与甲状腺髓样癌颈淋巴结转移相关临床研究(附48例临床分析)

Clinical study on the relationship of basal calcitonin and medullary carcinoma of the thyroid(MTC) neck lymph node metastasis(analysis of 48 cases)

目的 研究基础水平降钙素与甲状腺髓样癌颈淋巴结转移规律及对治疗的作用。方法 自 1989年 5月至 1997年 10月对我院外科治疗的 48例甲状腺髓样癌进行基础水平降钙素检测 ,并分析其和手术范围的关系。结果 48例甲状腺髓样癌中 3 6例行甲状腺癌颈淋巴结清除术 ;8例行甲状腺癌局部广泛切除术 ;4例行患侧甲状腺叶加峡叶切除术。 48例甲状腺髓样癌中 ,基础水平降钙素正常者 2 0例 ,术后病理检查发现淋巴结阳性者 4例 ,淋巴结转移率为2 0 %。基础水平降钙素升高者 2 8例 ,术后病理检查淋巴结阳性者 2 7例 ,淋巴结转移率 96.4%。结论 基础水平降钙素与甲状腺髓样癌颈淋巴结转移呈正相关。升高时 ,应行颈淋巴结清除术。基础水平降钙素正常时临床上无颈淋巴结转移的病人 ,可暂行患侧甲状腺叶加峡叶切除 ,术后紧密随访 ,并予以基础水平降钙素监测。

Objective To study the significance of calcitonin in MTC neck lymph node metastasis.Methods The basal calcitonin levels of 48 MTC patients from May 1989 to October 1997 were determined and the relation of calcitonin level and operation range was analysed.Of the 48 MTC patients,neck lymph node dissection,local extensive node dissection and dissection of affected thyroidea and isthmus were conducted in 36,8 and 4 cases respectively.Results The basal calcitonin levels of 20 cases were normal with 4 cases pathologically confirmed node metastasis,the lymh node metastatic rate being 20%.The levels of 28 patients were above the normal with node metastasis of 27 cases,the lymph node metastatic rate being 96.4%.Conclusion The level of basal calcitonin is correlated with neck node lymph node metastasis.If the value is above the normal range,the patient should receive neck dissection.If the value is within the range and meanwhile without clinical neck lymph node metastasis,the patient may only undergo the dissection of affected thyroidea and isthmus,but should be closely followed up and determined on the level of calcitonin.