局部进展期甲状腺癌侵犯气管、食管的外科处理  

Surgery of locally advanced thyroid carcinoma invading trachea and esophagus

作　　者：樊友本 邓先兆 顾晓辉 易红良[2] FAN You-ben;DENG Xian-zhao;GU Xiao-hui(Center of Thyroid,Shanghai Jiao Tong University&Shanghai Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院、上海交通大学甲状腺疾病诊治中心,上海200233 [2]上海交通大学医学院附属第六人民医院、耳鼻咽喉-头颈外科,上海200233

出　　处：《中国实用外科杂志》2023年第8期867-869,共3页Chinese Journal of Practical Surgery

基　　金：上海市(申康)甲状腺癌特色专病队列数据库的建设和应用项目(No.SHDC2020CR6003-00)。

摘　　要：局部进展期甲状腺癌可侵犯气管和食管,严重威胁病人生命安全、降低生活质量。术前可以通过超声、病理学检查、增强CT、增强MRI,必要时行气管镜、食管镜等检查作精准化评估。对于肿瘤侵犯气管者,需要根据受侵的深度和范围,采取气管壁削除、袖状或窗式切除后,进行直接缝合、端端吻合、肌骨膜瓣或皮瓣修补、气管造瘘;对于肿瘤侵犯食管者,多为肌层受侵,切除后直接缝合,少数为全层侵犯,切除后分层缝合,极少需要作胃上提或空肠或游离皮瓣代食管修复重建。根治切除是甲状腺癌侵犯气管、食管后唯一的治愈手段,需防治术后气管瘘、食管瘘等并发症,手术难度大、风险高,多采用多科联合手术,以提高成功率。术前新辅助靶向治疗有时可使不可切除手术转变为可切除手术,但要严格掌握用药指征和时长。Locally advanced thyroid cancer(LATC)can invade the trachea and esophagus,seriously threatening the life safety of patients and reducing the quality of life.Preoperative accurate evaluation can be performed by ultrasound,pathology,enhanced CT or MRI,electronic tracheoscopy,or esophagoscopy if necessary.For patients with LATC invasion of the trachea,according to the depth and extent of tumor invasion,shave,window resection covered with flap,or sleeve resection with end-to-end anastomosis or tracheotomy will be performed.LATC invasion of the esophagus,mostly its muscle layer,can be locally removed and directly sutured,and a few need to be repaired by gastric lift or Jejunum for esophagus replacement.Radical surgery is the only cure for LATC invasion of the trachea and esophagus.It is important to prevent and treat complications such as tracheal or esophageal fistula.Due to surgical difficulty and risk,MDT should be recommended.Preoperative targeted drug therapy can sometimes transform inoperable tumor into operable tumors,but indications must be strictly followed.

关 键 词：局部进展期甲状腺癌 气管侵犯 食管侵犯 手术治疗 

分 类 号：R736.1[医药卫生—肿瘤]