侵犯上呼吸消化道甲状腺癌的治疗

刘宏伟; 李振东; 董慧蕾; 冷辉; 孙海波; 李树春

doi:10.13201/j.issn.1001-1781.2014.24.006

侵犯上呼吸消化道甲状腺癌的治疗

- 1 辽宁中医药大学耳鼻咽喉科(沈阳, 110847);
- 2 辽宁省肿瘤医院头颈外科

详细信息

通讯作者: 李振东,E-mail:1349946150@qq.com

中图分类号: R736.1

收稿日期: 2014-05-15

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

- 1 Department of Otolaryngology, Liaoning University of Traditional Chinese Medicine, Shen-yang, 110847, China;
- 2 Department of Head and Neck Surgery, Liaoning Cancer Hospital, Shenyang

More Information

Corresponding author: LI Zhendong, E-mail: 1349946150@qq.com

Received Date: 15 May 2014

摘要

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。
- 甲状腺肿瘤 /
- 气管缺损 /
- 气管重建 /
- 修复外科手术
Abstract: Objective:To summary the clinical therapy experience of thyroid carcinoma invading cervical esophagus 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 subtotal 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 favorable turn a month later. Seven cases were dead(21.21%).1-year, 3-year, 5-year survival rates of the thyroid papillary carcinoma inviding cervical esophagus and trachea were 100.0%,93.8% and 70.3%;1-year, 3-year, 5-year survival rates of the thyroid carcinoma inviding cervical esophagus and trachea were 96.6%,79.0% and 61.4%.Conclusion:Thyroid carcinoma invading cervical esophagus and trachea full-thickness can be treated with surgical methods, and tracheal sleeve resection and end to end anastomos are the suitable methods.
- thyroid neoplasms /
- tracheal defect /
- tracheal reconstruction /
- reconstructive surgical procedures

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参考文献(14)

[1]	URKEN M L.Prognosis and management of invasive well differentiated thyroid cancer[J].Otolaryngol Clin North Am, 2010, 2:301-328.
[2]	HONINGS J, STEPHEN A E, MARRES H A, et al.The management of thyroid carcinoma invading the larynx or trachea[J].Laryngoscope, 2010, 4:682-689.
[3]	ISHIHARA T, YAMAZAKI S, KOBAYASHI K, et al.Resection of the trachea infiltrated by thyroid carcinoma[J].Ann Surg, 1982, 195:496-500.
[4]	赵雪柠, 叶萍, 潘新良.晚期甲状腺癌累及喉、气管和食管的外科治疗[J].山东大学耳鼻喉眼学报, 2007, 21 (3):260-262.
[5]	SYWAK M, PASIEKA J L, MCFADDEN S, et al.Functional results and quality of life after tracheal resection for locally invasive thyroid cancer[J].Am J Surg, 2003, 5:462-467.
[6]	SHIN D H, MARK E J, SUEN H C, et al.Pathologic staging of papillary carcinoma of the thyroid with airway invasion based on the anatomic manner of extension to the trachea:a clinicopathologic study based on 22patients who underwent thyroidectomy and airway resection[J].Hum Pathol, 1993, 24:866-870.
[7]	徐伟, 唐平章.高分化甲状腺癌侵犯喉气管的治疗[J].中华医学杂志, 2001, 81 (21):1228-1230.
[8]	KASPERBAUER J L.Locally advanced thyroid carcinoma[J].Ann Otol Rhinol Laryngol, 2004, 113:749-753.
[9]	MATTAVELLI F, BOMBARDIERI E, COLLINI P, et al.Role of surgery in treatment of advanced differentiated thyroid carcinomas[J].Acta Otorhinolaryngol Ital, 2007, 27:62-67.
[10]	CZAJA J M, MCCAFFREY T V.The surgical management of larngotracheal invasion by well-differentiated papillary thyroid carcinoma[J].Arch Otolarngol Head Neck Surg, 1997, 5:484-490.
[11]	PRICE D L, WONG R J, RANDOLPH G W.Invasive thyroid cancer:management of the trachea and esophagus[J].Otolaryngol Clin North Am, 2008, 41:1155-1168.
[12]	沈晓辉, 张建伟, 高下, 等.分化型甲状腺癌侵犯喉气管的处理[J].江苏医药, 2007, 33 (3):315-315.
[13]	KIM A W, MAXHIMER J B, QUIROS R M, et al.Surgical management of well-differented thyroid cancer locally invasive to the respiratory tract[J].Am Coll Surg, 2005, 201:619-627.
[14]	HIGASHIYAMA T, ITO Y, HIROKAWA M, et al.Induction chemotherapy with weekly paclitaxel administration for anaplastic thyroid carcinoma[J].Thyroid, 2010, 20:7-14.