分化型甲状腺癌侵犯气管的外科治疗15例分析

Surgical Treatment of Well-differentiated Thyroid Carcinoma Invading Trachea:A Report of 15 Cases

背景与目的:目前,对侵犯气管的分化型甲状腺癌(WDTC)外科治疗意见尚不一致,各国专家各抒己见。本文着重探讨WDTC侵犯气管的外科治疗方法及其临床意义。方法:回顾性分析15例WDTC侵犯气管患者的临床资料,根据分化型甲状腺癌侵犯颈段气管的范围及程度,我们将根治性手术切除后气管缺损处理方法分为1)气管端端吻合法;2)组织瓣修复法;3)喉、气管分离法。结果:15例患者均接受根治性手术切除和气管缺损修复重建或喉气管分离处理。其中气管端端吻合2例,胸锁乳突肌皮瓣修复5例,胸大肌肌皮瓣修复2例,颈阔肌皮瓣修复2例,游离前臂皮瓣并多孔钛板修复2例,喉、气管分离喉部封闭、气管造瘘2例。本组病例术后拔除气管套10例,拔管率为66.67%。拔除气管套的患者,恢复喉发音讲话及维持呼吸道通气功能。未能拔除气管套的5例中,胸锁乳突肌肌皮瓣修复1例,前臂皮瓣并多孔钛板修复1例,胸大肌肌皮瓣修复1例。喉、气管分离永久性气管造瘘2例。这5例均丧失喉发音功能,需终生佩带气管套或需作永久性气管造瘘。本组患者肿瘤复发率为33.33%,五年生存率为88.89%。结论:对侵犯气管分化型甲状腺癌患者应采取更为积极的外科治疗,切除所有肿瘤病变和受累组织器官,以减少术后复发,提高生存率。

BACKGROUND &OBJECTIVES: At present head and neck surgeons from m an y countries have different opinions on management of well-differentiated thyroi d cancer(WDTC). We will discuss WDTC invading trachea surgical treatment and its clinical significance. METHODS: Retrospectively reviewed clinical data of 15 ca ses WDTC invading trachea, According to WDTC invading extent and grade, there we re 3 kinds of surgical approaches: 1) end to end anastomosis; 2) tissue flap rec onstruction; 3)larynx-tracheal dissociation. RESULTS: 15 cases underwent radica l resection and reconstruct the defect of tracheal or larynx-tracheal dissociat ion. 2 cases received directly suture, 5 cases received sternocleidomastoid musc le flap reconstruction, 2 cases received pectorlis major muscle flap reconstruct ion, 2 cases received platysma flap reconstruction, 2 cases received free forear m flap with muticore titanium-board reconstruction, 2 cases received larynx-tr acheal dissociation with larynx block out and tracheal fistula. 10 cases (10/15, 66.7%) received decannulation postoperation. Patients who were success fully d ecannulated could recover phonation and maintain airway breath. In the 5 patient s who couldnt decannulate, underwent sternocleidomastoid muscle flap reconstru ction,1 underwent free forearm flap with muticore titanium-board reconstruction , 1 underwent pectorlis major muscle flap reconstruction, 2 underwent larynx-tr acheal dissociation, but all of them conld har dly utter voice by compress trach eostowa and needed permanent trcheostoma due to collapse of trachea. The recurre nce rate of our group is 33.33%, 5 years survival rate is 88.89%. CONCLUSIONS: WDTC with trachea invading easily cause dyspnea or emptysis influencing on 5 ye ars survival rate. We should take more actively surgical approach to resect all the tumor and involved organ, thus improve survival rate and reduce recurrence p ostoperation.