高分化型甲状腺癌侵犯气管的外科治疗

Surgical Treatment for Well-Differentiated Thyroid Carcinoma Invading Trachea

目的探讨高分化型甲状腺癌侵犯气管的临床特点及手术治疗方法。方法对43例高分化型甲状腺癌侵犯气管患者行肿瘤削除术、气管部分切除气管造瘘术、气管袖状切除术和姑息手术。比较各种手术方式的局部复发率及手术并发症。结果34例行根治性手术(包括肿瘤削除术、气管部分切除术、气管袖状切除术)5年局部控制率82·4%(28/34),姑息性手术加术后放射治疗5年局部控制率44·4%(4/9)。9例行姑息性手术患者的生存期比较短。结论根据高分化甲状腺癌侵犯气管的范围和程度,采取相应的手术方式,可达到切除肿瘤,减少复发,保留喉功能和延长生存期的目的。

Objective To investigate the clinical characteristics and surgical treatment of well-differentiated thyroid carcinoma with tracheal resection.Methods 4 cases with well-differentiated thyroid carcinoma with tracheal invasion were treated by different kinds of surgical modalities. Some patients received postoperative radiotherapy. The follow-up periods were -16 years with an average of 5 years.Result In the 4 cases with tumor radical resection, the local recurrent rate of 5-year was 17.6%(6/4). In the 9 cases with tumor incomplete resection, the local recurrent rate of 5-year was 55.6%(5/9). The survival rate of the incomplete resection group was significantly lower than that of the radical resection group.Conclusion According to the degree of invasion, adequate surgical procedure can obtain both cancer resection and organ preservation. Postoperative radiation may decrease relapse and prolong survival.