Dralle H, Damm I, Scheumann G F, Kotzerke J, Kupsch E
Klinik fur Abdominal- und Transplantationschirurgie, Medizinischen Hochschule Hannover, Germany.
Henry Ford Hosp Med J. 1992;40(3-4):264-7.
The frequency and significance of cervicomediastinal lymph node metastases have been investigated in 82 medullary thyroid carcinoma (MTC) patients retrospectively comparing two surgical techniques of lymph node dissection: selective lymphadenectomy (n = 63) versus compartment-oriented microdissection (n = 35). No positive correlation was observed between primary tumor size and the number of lymph node metastases. In patients with lymph node metastases proven histologically, 42% showed only cervical involvement (35% unilateral--type A, 7% bilateral--type B) and 22% cervicomediastinal lymph node involvement (15% cervico-unilateral and mediastinal--type C, 7% cervicobilateral and mediastinal--type D). Biochemical cure was 83% in node-negative patients but only 21% in node-positive patients. In node-positive MTC, calcitonin normalization was achieved in none with bilateral lymph node involvement but only in those unilateral lymph node metastases (31% in type A, 17% in type C). Survival and biochemical cure are significantly improved by application of the compartment-oriented microdissection method more so at primary surgery than at reoperation.
对82例甲状腺髓样癌（MTC）患者进行回顾性研究，比较了两种淋巴结清扫手术技术：选择性淋巴结切除术（n = 63）与分区显微解剖术（n = 35），以探讨颈纵隔淋巴结转移的频率和意义。未观察到原发肿瘤大小与淋巴结转移数量之间存在正相关。在组织学证实有淋巴结转移的患者中，42%仅表现为颈部受累（35%为单侧——A型，7%为双侧——B型），22%表现为颈纵隔淋巴结受累（15%为颈单侧和纵隔——C型，7%为颈双侧和纵隔——D型）。淋巴结阴性患者的生化治愈率为83%，而淋巴结阳性患者仅为21%。在淋巴结阳性的MTC中，双侧淋巴结受累者无一实现降钙素正常化，只有单侧淋巴结转移者实现了降钙素正常化（A型为31%，C型为17%）。应用分区显微解剖术可显著提高生存率和生化治愈率，在初次手术时比再次手术时效果更明显。
