Marchesi M, Biffoni M, Tartaglia F, Lentini A, Nuccio G, Stocco F, Jaus M, Tromba L, Berni A, Sgueglia M
Università degli Studi di Roma, La Sapienza.
Ann Ital Chir. 1995 Nov-Dec;66(6):825-9.
The authors report their experience and surgical treatment of 440 patients with differentiated carcinoma of the thyroid (DCT) from 1970 to 1990 in the III Surgical Dept. at the University of Rome "La Sapienza". Considering 305 cases of papillary carcinoma, 103 Total Thyroidectomy (TT), 118 TT with Functional Regional Lymphadenectomy (FRL), 32 TT with Node-Picking, 51 TT with curative FRL and one TT with Radical Neck dissection were performed. In 135 cases of follicular carcinoma TT associated with Node-picking were performed on two patients, TT associated with FRL on 8 patients and TT associated with RND on 2 patients. Overall survival to 10 years was 90%; 98% for N- papillary carcinoma and 66% for N+ follicular carcinoma. There were no permanent recurrence of disease. Out of the patients who did not undergo cervical lymphadenectomy 30% developed temporary hypocalcemia; 53% (mediastinal lymphadenectomy) to 87% (FRL) of the patients submitted to lymphadenectomy developed temporary hypocalcemia with permanent hypoparathyroidism in 0.9%-23% of the cases. On the base of what has been observed by Pasieka and Grant, the Authors believe TT as the absolute solution for patients with DCT because it allows the removal of both the original tumor and the possible neoplasms in the residual gland tissue, and enables early identification of other metastases which can be treated efficaciously with I131.
作者报告了1970年至1990年期间在罗马“La Sapienza”大学第三外科对440例甲状腺分化癌（DCT）患者的治疗经验及手术治疗情况。其中乳头状癌305例，施行全甲状腺切除术（TT）103例、全甲状腺切除术加功能性区域淋巴结清扫术（FRL）118例、全甲状腺切除术加淋巴结摘取术32例、全甲状腺切除术加根治性FRL 51例、全甲状腺切除术加根治性颈部清扫术1例。在135例滤泡状癌患者中，2例施行全甲状腺切除术加淋巴结摘取术，8例施行全甲状腺切除术加FRL，2例施行全甲状腺切除术加根治性颈部清扫术。10年总生存率为90%；N-乳头状癌为98%，N+滤泡状癌为66%。无疾病永久复发。未接受颈部淋巴结清扫术的患者中，30%出现暂时性低钙血症；接受淋巴结清扫术的患者中，53%（纵隔淋巴结清扫术）至87%（FRL）出现暂时性低钙血症，其中0.9%-23%的病例出现永久性甲状旁腺功能减退。基于帕西卡和格兰特的观察结果，作者认为全甲状腺切除术是DCT患者的绝对治疗方案，因为它既能切除原发肿瘤，又能切除残留腺组织中可能存在的肿瘤，还能早期发现其他可通过I131有效治疗的转移灶。
