侵及喉、气管、食管、下咽的甲状腺癌16例的手术处理  

Surgical Management of Thyroid Carcinoma Invading the Larynx,Trachea,Esophagus and Hypopharynx

作　　者：陈立[1] 吴皓[1] 

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科,200092

出　　处：《中国眼耳鼻喉科杂志》2006年第5期294-295,共2页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的探讨侵犯喉、气管、食管、下咽的甲状腺癌的手术处理及疗效。方法对16例该类患者的诊治情况进行回顾性的分析。术前声带麻痹8例,颈部肿块16例,颈部淋巴结肿大13例。手术在切除原发灶和行颈淋巴清扫术的同时对仅侵及气管软骨膜、下咽、食管壁外层的用电刀剔除;对喉、气管、食管、下咽全层受累者,切除受累部分的器官,采用气管端端吻合,胸锁乳突肌锁骨肌骨膜瓣(或肌骨瓣),胸大肌折叠皮瓣等方法重建上气道及上消化道。结果 16例患者随访0.5～5.0年,1例死亡,其余存活。术后出现咽瘘1例,换药后愈合。2例出现一过性误咽。2例双侧喉返神经受侵切除的患者戴气管套管发音。结论按照肿瘤外科的原则完整切除肿瘤的同时尽量保留和修复重建喉、气管、下咽、食管的功能,能提高患者的生存率和生存质量。Purpose To explore the surgical management and its efficacy in the treatment of thyroid carcinoma invading the larynx, trachea, esophagus or hypopharynx. Methods The data of 16 cases with thyroid carcinoma, which had invaded the neighboring area such as larynx, trachea, esophagus or hypopharynx, were analyzed retrospectively.All the patients were found to have neck mass（es）. Thirteen cases displaysed swelling neck lymph node（s）. Eight cases had vocal paralysis. The outer wall tissue which was invaded was resected with a electricity sword, after the primary thyroid lesions were resected and neck dissection were completely performed. When all the layers of the larynx, trachea, esophagus or hypopharynx were invaded, the invaded part of the organ was reacted. End to end anastomosis of the trachea was made and reconstruction of esophagus was performed with folded pectoralis major myocutaneous flap, sternocleidomastoideus flap with clavicularperiosteum flap（or clavicle skinnes flap）. Results The 16 patients were followed up for 0.5 to 5 years respectively. Most patients are survival except one died. One patient ever appeared pharyngeal fistula after operation but the wound was healed. Two patients whose bilateral laryngeal recurrence nerve had been resected during operation could speak with a trecheal cannuka. Conclusion The survial rate could be increased and the life quality improved when overall neoplasms were resected and the organ＇s function was presented and reconstructed to the best of our abilities.

关 键 词：甲状腺肿瘤 气管 食管 下咽 喉 重建 

分 类 号：R736.1[医药卫生—肿瘤]