气管支架在甲状腺肿瘤致气管狭窄外科手术中的临床应用  

Tracheal stent in surgery for tracheal stenosis caused by thyroid tumor

作　　者：张悦嘉 王朝晖[2] 包郁[3] 陈锦[2] 李春华[2] 张可贤[4] Zhang Yuejia, Wang Zhaohui,Bao Yu, Chen Jin, Li Chunhua,Zhang Kexian(1.Guangxi Medical University Graduate School, Nanning 530021, China;2.Department of Head and Neck Surgery, Sichuan Cancer Hospital,Chengdu 610041, China;3.Department of Endoscopy, Sichuan Cancer Hospital, Chengdu 610041, China; 4.Department of Anesthesia, Sichuan Cancer Hospital, Chengdu 610041, Chin)

机构地区：[1]广西医科大学研究生院,南宁530021 [2]四川省肿瘤医院头颈外科,成都610041 [3]四川省肿瘤医院内镜室,成都610041 [4]四川省肿瘤医院麻醉科,成都610041

出　　处：《中华内分泌外科杂志》2018年第1期47-50,共4页Chinese Journal of Endocrine Surgery

基　　金：四川省卫计委课题（150239）

摘　　要：目的探讨气管支架在甲状腺肿瘤致气管狭窄的手术中的临床应用及效果。方法回顾性分析2015年10月至2016年9月四川省肿瘤医院头颈外科收治的6例因甲状腺肿瘤侵犯或压迫气管致气管狭窄、呼吸困难的临床资料，其中结节性甲状腺肿1例，分化型甲状腺癌（differentiated thyroid carcinoma，DTC）5例。结果所有患者均因甲状腺肿瘤侵犯或压迫气管致呼吸困难，局麻下行气管支架置入后呼吸困难症状明显改善，后限期行甲状腺肿瘤切除手术，术中气管插管、麻醉及手术顺利，1例良性结节性甲状腺肿次全切除，5例DTC侵犯气管，行甲状腺全切及颈部淋巴结清扫术，受侵气管袖状切除端端吻合；所有患者伤口Ⅰ期愈合。5例DTC术后均行碘131治疗及TsH抑制治疗。随访时间4～15个月，均健在，无肿瘤复发。结论因甲状腺肿瘤侵犯或压迫气管致气管狭窄的患者，气管插管困难，需在体外循环下进行手术，对没有体外循环条件的医院，行气管支架置入术可有效改善患者呼吸困难等危急症状同时降低麻醉气管插管的风险，为外科治疗提供可能性。Objective To discuss clinical application, value and effect of tracheal stent in surgical oper- ation for tracheostenosis caused by thyroid tumor. Methods Clinical data of 6 patients with tracheal stenosis and dyspnea caused by thyroid tumor invasiveness or tracheal compression from Oct. 2015 to Sep. 2016 were retrospectively analyzed. Of the 6 patients, 1 case had nodular goiter and 5 cases had differentiated thyroid carcinoma（DTC）. Results All patients had dyspnea caused by thyroid tumor invasiveness or tracheal compression. Dyspnea relieved dramatically after tracheal stent was implantated under local anesthesia. Thyroidectomy was given later, with intraoperative tracheal intubation as well as anesthesia, and the surgery finally succeeded. One case with benign muhinodular goiter received complete resection and 5 cases with DTC invading the trachea re- ceived complete resection of thyroid and neck lymph node dissection, followed by end-to-end anastomosis of in- vaded trachea sleeve resection. All patients got stage I healing in surgical wound. Five cases received radioactive 131I treatment as well as TSH suppression therapy after DTC surgery. All patients were alive and disease-free after a follow-up of 4 to 15 months. Conclusions For patients with tracheostenosis caused by thyroid tumor inva- siveness or tracheal compression, operation under cardiopulmonary bypass is necessary if tracheal intubation is difficult. For hospitals without cardiopulmonary bypass, tracheal stent implantation can effectively relieve dyspnea symptom and reduce risk of tracheal intubation under anesthesia, which provides possibility for surgical treatment.

关 键 词：甲状腺肿瘤 气管支架置入术 呼吸困难 气管狭窄 

分 类 号：R736.1[医药卫生—肿瘤]