侵及喉或食管的分化型甲状腺癌的手术治疗  

Surgical treatment for differentiated thyroid carcinoma with invasion of larynx and esophagus

作　　者：董频[1] 谢晋[1] 英信江[1] 张佳[1] 王国良[1] 张柏涛[1] 陈歆维[1] 徐宏鸣[1] 王果[1] 

机构地区：[1]上海交通大学附属第一人民医院耳鼻咽喉-头颈外科,上海200080

出　　处：《上海医学》2014年第3期220-222,共3页Shanghai Medical Journal

摘　　要：目的探讨侵及喉和食管的分化型甲状腺癌的手术治疗效果。方法回顾性分析2000-2012年经手术治疗的125例分化型甲状腺癌患者的临床资料,所有患者均行甲状腺癌根治性手术,术中根据受累情况分别切除喉返神经,自气管壁上切下肿瘤,以及切除甲状软骨、喉、部分气管和食管。对于较小的气管缺损可不用邻近组织修补而由带状肌支撑,或放置气管套管;较大的缺损可采用胸锁乳突肌锁骨膜、胸大肌皮瓣重建。对于肿瘤切缘不足者,术后辅以放射治疗。结果本组125例患者中,50例患者行部分气管软骨切除并保留内膜;25例患者行甲状软骨部分切除;21例患者行气管窗状切除;5例患者行气管环状切除;5例患者行喉部分切除;2例患者行全喉切除;11例患者行食管修复;6例患者自甲状软骨、气管、食管壁剥下肿瘤,或切除部分管壁但无需修补。术中发现肿瘤侵犯喉返神经34例,其中33例患者一侧喉返神经受侵犯,1例患者双侧喉返神经均受侵犯;11例患者术前有一侧声带固定,术后20例患者出现声带固定。上述患者均存活,术后5年内无1例死亡。结论有效切除侵犯喉或食管的晚期甲状腺癌并给予辅助治疗,可获得良好的远期效果。Objective To explore the surgical therapy for differentiated thyroid carcinoma with invasion of the adjacent structures such as the recurrent laryngeal nerve, larynx, trachea and esophagus. Methods A total of 125 patients with differentiated thyroid carcinoma treated by radical resection between 2000 and 2012 were enrolled in this retrospective study. According to the invasion of thyroid cancer, the recurrent laryngeal nerve, tumor on the tracheal wall, thyroid cartilage, larynx, trachea and esophagus were resected. The small defect of tracheal was repaired with adjacent tissue or treated with tracheal tube, while a large defect was constructed with free sternocleidomastoid clavicle membrane or pectoralis major myocutaneous flap. If the surgical cutting edge was positive, postoperative radiation therapy should be critical for locally invasive thyroid cancer. Results In the 125 cases, 50 underwent partial trachea cartilage resection （the intima was reserved）, 25 underwent partial thyroid cartilage resection, 21 underwent window tracheal resection, 5 underwent tracheal resection, 5 underwent partial laryngectomy, 2 underwent total laryngectomy, 11 underwent esophageal reconstruction, and 6 underwent local stripping-off or partial tracheal wall resection without repair. Recurrent laryngeal nerve was involved in 34 cases （33 involved in unilateral nerve and 1 in bilateral nerve）. Fixation of vocal cords occurred in 11 cases before surgery and in 20 after surgery. Five-year survival rate was 100% in this study. Conclusion For the advanced thyroid carcinoma with invasion of the larynx and esophagus, the effective resection with the adjuvant therapy can preserve functions and achieve satisfactory long-term effect.

关 键 词：分化型甲状腺癌 喉 食管 手术 

分 类 号：R736.1[医药卫生—肿瘤]