高分化甲状腺癌侵犯喉气管的治疗及预后  

The management and prognosis of laryngotracheal invasion by well-differentiated thyroid carcinoma

作　　者：徐先发[1] 李正江[2] 王洵[1] 唐平章[2] 

机构地区：[1]首都医科大学附属北京朝阳医院耳鼻咽喉头颈外科,北京100020 [2]中国医学科学院中国协和医科大学肿瘤医院头颈外科

出　　处：《中华医学杂志》2004年第22期1888-1891,共4页National Medical Journal of China

摘　　要：目的　探讨高分化甲状腺癌 (DTC)喉气管受侵的治疗及预后。方法　回顾性分析 1976～ 1996年间 86例DTC侵犯喉气管的患者资料。根据肿瘤侵犯喉气管的范围和程度不同分别行肿瘤削除术 39例、根治性切除 2 1例 (气管窗式切除 11例、气管袖状切除 8例和全喉切除 2例 )和姑息性切除 2 6例。部分患者术后补充放疗。生存率比较采用Kaplan Meier法。结果　① 39例喉气管局限性受侵行肿瘤削除术者 ,5年和 10年生存率分别为 92 3% ( 36 /39)和 75 9% ( 2 2 /2 9)。术后放疗 9例 ,术后未放疗 30例。对于肿瘤削除术患者 ,术后放疗与术后未放疗 ,其 5年和 10年生存率差异均无显著性 (P >0 0 5 )。② 2 1例肿瘤侵及喉气管腔内行根治性切除者 ,5年和 10年生存率分别为 85 7%( 18/2 1)和 5 3 9% ( 7/13)。术后放疗 11例 ,术后未放疗 10例。对于肿瘤侵及喉气管腔内行根治性切除者 ,术后放疗与术后未放疗 ,其 5年和 10年生存率差异均无显著性 (P >0 0 5 )。③ 2 6例姑息切除患者 ,5年和 10年生存率分别为 5 0 0 % ( 13/2 6 )和 19 2 % ( 5 /2 6 )。 9例术后放疗患者 ,5年和 10年生存率分别为 77 8% ( 7/9)和 5 5 6 % ( 5 /9)。 17例术后未放疗患者 ,5年生存率为 35 3% ( 6 /17) ,随访 10年无生存者。对于姑息切除?Objective To explore the treatment and prognosis on patients with laryngotracheal invasion by well-differentiated thyroid carcinoma(DTC). Methods Eighty-six patients treated for DTC with laryngotracheal invasion between 1976 and 1996, from Beijing Chaoyang Hospital and Cancer Hospital, Chinese Academy of Medical Sciences, were retrospectively analyzed. The different kinds of surgical modalities were performed according to the extent of laryngotracheal invasion by DTC, including shave excision (39 cases), tracheal window resection (11 cases), circumferential sleeve resection (8 cases), total laryngectomy (2 cases) and incomplete tumor resection (26 cases). Some patients received postoperative radiotherapy. Survival was evaluated using the Kaplan-Meier method.Results (1) Thirty-nine patients with laryngotracheal invasion were treated with shave excision, the 5- and 10-year survival rates were 92.3% (36/39) and 75.9%(22/29), respectively. Nine patients received postoperative radiotherapy, 30 patients didn't received postoperative radiotherapy. After a shave excision, the differences of 5- and 10- year survival rates between the irradiated and nonirradiated patients were not statistically significant ( P >0.05). (2) Twentyone patients underwent radial excision for intraluminal involvement extending through the laryngotracheal cartilage, including circumferential sleeve resection, tracheal window resection and total laryngectomy, the survival rate was 85.7% (18/21) for five years and 53.9%(7/13) for ten years. Eleven patients received postoperative radiotherapy, 10 patients didn't received postoperative radiotherapy. After a radial excision, the differences of 5- and 10- year survival rates between underwent irradiated and nonirradiated patients were not statistically significant ( P >0.05). (3) For the 26 patients receiving the incomplete resection, the 5- and 10- year survival rates were 50.0%(13/26) and 19.2% (5/26), respectively. For 9 patients receiving postoperative radiotherapy, the 5- and 10- year surv

关 键 词：气管 肿瘤 生存率 术后放疗 患者 治疗 腔内 高分 显著性 结论 

分 类 号：R736.1[医药卫生—肿瘤]