University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
University of Lund, Surgical Department, Skåne University Hospital, Malmö, Sweden.
Int J Surg. 2017 May;41 Suppl 1:S70-S74. doi: 10.1016/j.ijsu.2017.04.026.
Medullary thyroid carcinoma is an aggressive tumor and presents with significant morbidity and mortality and a high rate of lymph node metastases. The combination of total thyroidectomy and cervical lymphadenectomy is the essential treatment for those patients presenting with cervical lymph node metastases.
A retrospective analysis of 117 patients operated for medullary thyroid carcinoma over a period of 15 years at a single institution. Surgical complications and calcitonin levels were noted.
Nodal metastases were detected in the central compartment in 72.6% patients. Positive lymph nodes were detected in the lateral compartment of 34 patients who had undergone ipsilateral dissection and in all 10 patients of those with bilateral surgery. We found 3 cases of unilateral transient recurrent laryngeal nerve palsy, 15 cases of temporary hypoparathyroidism, a permanent accessory nerve lesion and a case of chylous fistula. Normalization of post-operative calcitonin was found in 82.6% and of patients who underwent total thyroidectomy and central neck dissection alone compared to 35.4% in those with ipsilateral and bilateral neck dissection.
Total thyroidectomy and cervical lymphadenectomy planned on the ultrasound preoperative study and on the calcitonin level represent the standard of treatment for medullary thyroid carcinoma.
甲状腺髓样癌是一种侵袭性肿瘤，具有较高的发病率、死亡率和淋巴结转移率。对于那些伴有颈部淋巴结转移的患者，全甲状腺切除术和颈部淋巴结清扫术是必要的治疗方法。
对 15 年来在一家机构接受甲状腺髓样癌手术的 117 例患者进行回顾性分析。记录手术并发症和降钙素水平。
72.6%的患者中央区淋巴结转移，34 例接受同侧清扫术的患者和所有 10 例双侧手术患者的侧区淋巴结均为阳性。我们发现 3 例单侧暂时性喉返神经麻痹，15 例暂时性甲状旁腺功能减退，1 例副神经永久损伤和 1 例乳糜瘘。术后降钙素正常化在接受全甲状腺切除术和中央颈部清扫术的患者中为 82.6%，而在接受同侧和双侧颈部清扫术的患者中为 35.4%。
基于术前超声检查和降钙素水平计划的全甲状腺切除术和颈部淋巴结清扫术是甲状腺髓样癌的标准治疗方法。
