甲状腺癌上纵隔和腋窝淋巴结转移的手术治疗  

Management of thyroid carcinoma with metastases in the upper mediastinum and axillary area

作　　者：魏伯俊[1] 申虹[1] 戈烽[2] 

机构地区：[1]首都医科大学附属北京世纪坛医院耳鼻咽喉头颈外科,100038 [2]首都医科大学附属北京世纪坛医院胸外科,100038

出　　处：《中华耳鼻咽喉头颈外科杂志》2013年第9期708-711,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：铁道部科技研究开发专项课题（J2012C005）

摘　　要：目的探讨甲状腺癌上纵隔和腋窝淋巴结转移的临床特点及手术疗效。方法回顾性分析2006年5月至2011年5月6例经病理证实的伴上纵隔及腋窝淋巴结转移甲状腺癌的诊治经过，其中甲状腺乳头状癌5例，滤泡状癌1例；首次治疗1例，外院1次术后复发2例（其中1例接受放射治疗60Gy），外院2次术后复发3例。采用甲状腺全切或残体切除术＋颈部、上纵隔及腋窝淋巴清扫术＋131I治疗＋左旋甲状腺素抑制治疗。结果腋窝淋巴结转移者分别为2／7、3／12、2／6、1／5、3／7及3／10。上纵隔转移淋巴结数目2～6枚，平均4．3枚，伴咽后间隙淋巴结转移1例（1／1）。术后暂时性低钙血症2例，乳糜漏1例，霍纳综合征3例，无新发喉返神经麻痹，无锁骨下动静脉或腋动静脉损伤，无上肢水肿、感觉或运动障碍者，无肺气肿或纵隔气肿者。术后分别随诊23、37、43、49、54及77个月，颈部淋巴结复发（同侧V区）和新发肺转移各1例，术前肺转移者转移灶较前无增大。上纵隔及腋窝未见复发或骨转移者。1例术后4年死于心脏病，其余均存活。结论发生上纵隔及腋窝淋巴结转移的分化型甲状腺癌仍有较好治疗效果，也相对安全。Objective To investigate the clinical characteristics and management of thyroid carcinoma with the upper mediastinal and axillary metastasis. Methods Six cases of thyroid carcinomas with metastases to mediastinum and axillary, in addition to the neck, undergoing surgeries from 2006 to 2011 were reviewed. Five cases was papillary carcinoma and one was follicular carcinoma. Of six patients, five underwent surgical treatment at least one time previously and one of them received a radiotherapy with total dose of 60 Gy. 131I treatment and thyroxine were used postoperatively in all cases. Results The numbers of metastatic nodes in the axillary were 2/7, 3/12, 2/6, 1/5, 3/7 and 3/10 respectively, while the nmnbers in the upper mediastinum ranged from 2 to 6, with a 4. 3 average, a metastatic lymph node in the retropharyngeal space was also found in one patient. Homer＇s sign occurred in three cases, temporary hypocalcemia in two cases and chylous fistula in one ease. No injury to the recurrent laryngeal nerve or to important vessels. Neck or lower mediastinum recurrence and new lung metastasis occurred in three cases separately. No recurrence in the upper mediastinum or axillary area was found with the follow-up of 23 -77 months. One died of heart disease 4 years after operation. Conclusion The surgical treatment of node metastases in the upper mediastinum and axillary from the well-differentiated thyroid cancer is safe and has a promising outcome.

关 键 词：甲状腺肿瘤 淋巴转移 腋 纵隔 淋巴结切除术 

分 类 号：R736.1[医药卫生—肿瘤]