侵犯气管的甲状腺恶性肿瘤呼吸通道建立方法初探  

A preliminary study on the establishment of trachea respiratory passage invaded by thyroid malignant tumor

作　　者：王丽芬[1] 黄志纯[1] Wang Lifen;Huang Zhichun(Department of Otorhinolaryngology Head and Neck Surgery,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]东南大学附属中大医院耳鼻咽喉头颈外科,南京210009

出　　处：《中华耳鼻咽喉头颈外科杂志》2022年第9期1066-1071,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨对于甲状腺恶性肿瘤晚期侵犯气管的病例,术前如何安全快速建立呼吸通道及其方法依据的判定。方法回顾性分析2016—2020年东南大学附属中大医院耳鼻咽喉头颈外科收治的14例甲状腺恶性肿瘤侵犯气管的病例资料,其中男性5例,女性9例,年龄24~79岁。Shin分级:Ⅱ级5例,Ⅲ级6例,Ⅳ级3例。根据肿瘤对气管压迫、侵犯程度及患者呼吸困难情况分为3类诊疗方案:对于气管最狭窄直径>5 mm(伴有Ⅰ-Ⅱ度呼吸困难8例,Shin分级为Ⅱ-Ⅲ级),经镇静、镇痛后,局部表面麻醉清醒气管插管;对于气管最狭窄直径为4~5 mm(伴有Ⅱ度呼吸困难3例,Shin分级为Ⅳ级),经面罩给氧局部麻醉行气管切开术;对于肿瘤侵犯压迫至气管最狭窄直径<4 mm(伴有Ⅲ度呼吸困难3例,Shin分级为Ⅲ级),则于体外循环支持下气管切开。结果14例患者均安全建立呼吸通道进行全身麻醉,12例分化型甲状腺癌患者行手术治疗;2例甲状腺组织活检病理分别为未分化癌和大B细胞淋巴瘤,行气管切开术后,肿瘤科及血液科进一步治疗。所有患者随访2~22个月,手术患者均无瘤生存;1例淋巴瘤患者血液科行化疗,随访期间无瘤生存;1例未分化癌患者生存期3个月。结论通过对患者气道狭窄程度分类评估,采取不同方法快速安全建立呼吸通道。对于手术患者,为进一步治疗提供安全保障,提高患者生存率;对于无手术指征的患者,为后续姑息维持治疗提供机会,在一定程度上延长了患者生存期。Objective To investigate the establishment of trachea respiratory passage invided by advanced thyroid malignant tumor.Methods Review of 14 cases with the establishment of trachea respiratory passage invided by advanced thyroid cancer was conducted who were treated at the Department of Otorhinolaryngology Head and Neck Surgery,Zhongda Hospital Southeast University between 2016 and 2020.There were 5 males and 9 females,aged from 24-79 years old.Shin grade was as follows,5 cases withⅡgrade,6 withⅢgrade,and 3 withⅣgrade.Based on the conditions of tracheal compression and tumor extent,three types of managements were used:patients with the narrowest tracheal diameter>5 mm(8 cases with dyspneaⅠ-Ⅱ,Shin gradeⅡ-Ⅲ)were applied with local surface anesthesia and conscious endotracheal intubation after sedation and analgesia;patients with the narrowest tracheal diameter with 4-5 mm(3 cases with dyspneaⅡ,Shin gradeⅣ)needed tracheotomy with local anesthesia by supplying oxygen with a mask;patients with the narrowest tracheal diameter<4 mm(3 cases with dyspneaⅢ,Shin gradeⅢ)needed tracheotomy with extracorporeal circulation.Results Respiratory passages for general anesthesia were safely established in all 14 patients,of whom 12 cases with differentiated thyroid carcinoma were treated with surgery,and 2 cases with undifferentiated thyroid carcinoma and B-cell lymphoma was treated with tracheotomy and then treated with chemotherapy in the Oncology or Hematology Department.All patients were followed-up for 2-22 months and survived without tumors,but one patient with undifferentiated carcinoma survived for 3 months.Conclusion Respiratory passage can be established quickly and safe in advanced thyroid malignant tumor.This provides a necessary safety for patients who are needed surgical treatment and also an opportunity for patients undergoing other treatments.

关 键 词：甲状腺肿瘤 气管肿瘤 肿瘤浸润 气道阻塞 

分 类 号：R736.1[医药卫生—肿瘤]