甲状腺癌侵犯上纵隔的外科治疗  

Surgical treatment of thyroid carcinoma with the upper mediastinal invasion

作　　者：葛俊恒[1] 赵瑞利[1] 胡俊兰[1] 周维安[1] 

机构地区：[1]河北医科大学第四医院耳鼻咽喉-头颈外科,石家庄050011

出　　处：《中华耳鼻咽喉科杂志》2004年第8期460-463,共4页Chinese Journal of Otorhinolaryngology

摘　　要：目的 探讨甲状腺癌侵犯上纵隔的外科治疗方法。方法 回顾性分析了河北医科大学第四医院耳鼻咽喉-头颈外科1988-1999年经治的516例甲状腺癌中10例侵犯上纵隔患者的术前诊断、手术进路、手术方法及术后并发症。结果 甲状腺癌侵及上纵隔的发病率占全部甲状腺癌的1.9％(10/516)。侵犯方式主要3种:①气管、食管沟及上纵隔淋巴结转移;②肿瘤的直接侵犯;③原发胸骨后恶性甲状腺肿瘤。手术方式有3种:①不切开胸骨的肿块切除;②加胸骨纵行切开的肿块切除;③胸骨部分或扩大切除术(包括锁骨)。完整切除肿瘤9例,姑息切除1例。术后乳糜漏2例,声带麻痹2例,甲状颈干动脉出血1例,膈神经麻痹1例,气胸1例。全部病例随访3年以上,1、3、5、10年生存率分别为10/10、8/10、6/9、4/7。结论 甲状腺癌侵犯上纵隔,采用手术治疗可获得良好的远期效果。Objective To study the surgical management of the thyroid carcinoma with the upper mediastinal invasion. Methods Among the 560 thyroid carcinoma cases receiving surgery from 1988 to 1999, there were 10 cases of the upper mediastinal , the 10 cases were retrospectively analyzed for their preoperative diagnosis , surgical methods and postoperative complications. Results The upper mediastinal invasion rate of the 560 cases was 1. 9% (10/516). There are three paths for the upper mediastinal invasion; ( 1) Trachea esophagus groove and upper mediastinal lymphatic node metastasis. ( 2 ) Tumor direct invasion. (3) Primary malignant substernal goiter. Operative methods include: ( 1 ) Tumor removal without using sternum incision. ( 2 ) Tumor removal with sternotomy. ( 3) Extension operation with sternum or/and clavicle bones removal. The number of those cases who survived 1 、 3 、 5 、 10 years were 10, 8, 6, 4 respectively. Radical removal of tumors was achieved in 9 cases. The complications occurred were: 2 cases of chylus fistula; 2 cases of vocal paralysis; 1 case of thyrocervical trunk artery bleeding; 1 case of phrenic nerve paralysis; 1 case of pueumothoras. Conclusions Surgery can be adopted for treating thyroid carcinoma with the upper mediastinal invasion, and it can have a good long-term prognosis.

关 键 词：甲状腺癌 上纵隔侵犯 外科治疗 甲状腺切除术 

分 类 号：R736.1[医药卫生—肿瘤]