侵犯喉、气管的分化型甲状腺癌的外科治疗  

Surgical treatment of differentiated thyroid carcinoma with larynx and trachea invasion

作　　者：王朝晖[1] 蔡永聪[1] 李春华[1] 陈锦[1] 于涛[1] 

机构地区：[1]四川省肿瘤医院头颈外科,610041

出　　处：《中华内分泌外科杂志》2014年第4期278-281,共4页Chinese Journal of Endocrine Surgery

摘　　要：目的：探讨累及喉、气管的分化型甲状腺癌的外科处理。方法对29例伴有喉、气管受累的分化型甲状腺癌患者行一期肿瘤切除。其中单纯喉受侵6例，喉、气管受侵3例，气管受侵16例，喉、气管受侵同时伴有带状肌及皮肤受侵4例；I型5例、II型4例、III型9例、IV型11例。所有患者均行甲状腺全切除术，喉、气管受侵者9例行肿瘤气管壁削除术（ I、II型），15例分别行气管窗状切除胸锁乳突肌肌骨膜瓣修复术、气管袖状切除端端吻合术、气管窗状切除造瘘术，3例行全喉切除术，2例部分喉切除术；4例胸大肌肌皮瓣修复皮肤软组织缺损。结果29例中乳头状腺癌25例，滤泡状腺癌4例；术后随访1～8年，就诊时伴有肺转移的3例术后均行内照射，肺转移灶控制2例，进展1例，带瘤生存；3例复发，2例气管壁复发再手术，1例颈部淋巴结复发放弃治疗术后40个月死亡。随访满3年25例，生存25例；随访满5年14例，生存13例。结论分化型甲状腺癌侵犯喉、气管时，应争取手术切除肿瘤组织，切勿放弃手术。应尽可能切除受累器官，这不仅可消除或缓解由出血及梗阻引起的窒息，且使患者有治疗的机会，同时通过皮瓣修复、气管端端吻合等技术重建喉、气管功能，以提高患者的生存质量。术后行规范的内分泌治疗、核医学治疗可改善患者预后。Objective To discuss the surgical treatment of differentiated thyroid carcinoma （ DTC） viola-ting larynx and trachea .Methods 29 patients with DTC violating larynx and trachea received primary tumor re-section.Among them, 6 patients were with larynx violation , 3 patients with larynx and trachea violation , 16 pa-tients with trachea violation , and 4 patients with anterior strap muscles and skin violation .In addition, 5 patients were type I , 4 patients type II , 9 patients type III , and 11 patients type IV .All patients accepted the total thy-roidectomy.For patients with larynx and trachea violations , 9 received the slashing tracheal surgery （ type I and II） , 15 patients received the window resection and sternocleidomastoid muscle periosteal flap reconstruction , sleeve resection and anastomosis reconstruction , and window resection and gastrostomy .3 patients received total laryngectomy , 2 patients received partial laryngectomy and 4 patients with skin invasion received the reconstruc-tion with pectoralis major muscle flap .Results For these patients , 25 patients were with papillary adenocarcino-ma, and 4 patients with follicular carcinoma .All patients were followed up for 1 to 8 years.3 cases suffered from recurrence, 2 cases with tracheal recurrence received reoperation .3 cases with lung metastasis received the I 131 therapy, among whom 2 cases achieved the local control of lung tumor and the other one survived with tumor .1 patient died of the neck lymph nodes recurrence .25 patients survived over 3 years.13 patients survived over 5 years.Conclusions For patients with DTC with larynx and trachea violation , we should try our best to eliminate the tumor tissues.For the organs invaded by tumors , if possibly, elimination is also needed .This will eliminate or release the suffocation resulted from bleeding or obstruction .In addition , the function of larynx and trachea can be reconstructed and the life quality of these patients can be improved through the flap reconstruction and trachea anastom

关 键 词：甲状腺癌 气管肿瘤 修复 

分 类 号：R736.1[医药卫生—肿瘤]