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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 and prognosis of standard and non-standard surgical treatment of sporadic medullary thyroid carcinoma. Methods The clinical data of 26 patients with medullary thyroid carcinoma treated in our hospital from January 2000 to March 2013 were retrospectively analyzed. According to the way of operation is divided into non-standardized operation group and standardized operation group (bilateral thyroidectomy + lymph node dissection). Postoperative biochemical cure, recurrent laryngeal nerve and parathyroid injury were analyzed in two groups. Results There was no significant difference in one-year biochemical cure rate between non-standardized surgery group and normalized surgery group (84.21% vs 100%, χ2 = 1.249 4, P> 0.05), and the 1-year recurrence rates were 15.79% and 0 , And the 5-year biochemical cure rate in the normalized operation group was significantly higher than that in the non-standardized operation group (100% vs 16.67%, χ2 = 4.444 4, P <0.05). The 5-year recurrence rates were 0 and 83.33% . There was no significant difference between the two groups in the rate of recurrent laryngeal nerve injury (χ2 = 0.0708, P> 0.05) and the incidence of hypoparathyroidism (χ2 = 2.7227, P> 0.05). Conclusions The standardized operation of sporadic thyroid medullary carcinoma can increase the biochemical cure rate of 5 years and reduce the recurrence rate without increasing the injury rate of the recurrent laryngeal nerve and parathyroid gland.