侵犯上呼吸消化道甲状腺癌的治疗  

Surgical treatment and reconstruction of thyroid carcinoma invading cervical esophagus and trachea full-thickness

作　　者：刘宏伟[1,2] 李振东[2] 董慧蕾[2] 冷辉[1] 孙海波[1] 李树春[2] 

机构地区：[1]辽宁中医药大学耳鼻咽喉科,沈阳1108472 [2]辽宁省肿瘤医院头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第24期1927-1930,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:总结侵犯上呼吸消化道甲状腺癌治疗的临床经验,提高其生存率和生活质量。方法:侵犯上呼吸消化道甲状腺癌患者33例中,全甲状腺切除7例,患侧腺叶切除对侧次全切除22例,甲状腺部分切除4例。气管局部切除开窗气管插管19例,部分喉、梨状窝切除气管局部切除开窗插管4例,气管袖状切除术、端端吻合10例。结果:所有患者均一期愈合,无气管吻合口瘘、气管壁坏死、食管瘘及咽瘘。1例出现甲状旁腺功能低下,术后1个月好转。死亡7例(21.21%)。侵犯上呼吸消化道甲状腺乳头状癌的1、3、5年生存率分别为100.0%、93.8%和70.3%;侵犯上呼吸消化道甲状腺癌的1、3、5年生存率分别为96.6%、79.0%和61.4%。结论:甲状腺癌侵入气管内、下咽可以手术治疗,恰当地选择术式可以提高生存率和生存质量。气管袖状切除、端端吻合是较理想的重建气管的方法。Objective： To summary the clinical therapy experience of thyroid carcinoma invading cervical e- sophagus and trachea full thickness and reconstruction of them to improve the survival rate and quality of life of these patients. Method：In 33 patients with thyroid carcinoma inviding cervical esophagus and trachea, 7 patients were operated with total thyroid resection,22 patients were operated with one lobectomy and the other side subto- tal thyroid resection,and 4 patients were operated with partial lobectomy. Trachea local recection and intubation were performed on 19 patients, partial laryngectomy and pyriform sinus resection with trachea local recection and intubation were performed on 4 patients,and 10 cases were operated with tracheal sleeve resection and end to end anastomos. Result：All patients were primary healing without tracheal anastomosis fistula, tracheal wall necrosis, esophageal fistula and pharyngeal fistula. One case had hypoparathyroidism after the operation and took a favora- ble turn a month later. Seven cases were dead（21.21%）. 1-year, 3-year, 5-year survival rates of the thyroid papil- lary carcinoma inviding cervical esophagus and trachea were 100.0%, 93.8% and 70.3% survival rates of the thyroid carcinoma inviding cervical esophagus and trachea were 96.6 %,7 Conclusion：Thyroid carcinoma invading cervical esophagus and trachea full-thickness can be methods, and tracheal sleeve resection and end to end anastomos are the suitable methods.

关 键 词：甲状腺肿瘤 气管缺损 气管重建 修复外科手术 

分 类 号：R736.1[医药卫生—肿瘤]