腺外浸润的晚期甲状腺癌的外科治疗

Surgical management of the advanced thyroid carcinoma with extrathyroidal invasion

为评价腺外浸润的晚期甲状腺癌的手术疗效和预后，回顾性分析了16例手术治疗的甲状腺癌病例，其中侵及范围为气管、食管、喉、喉返神经、下咽和颈部大血管等。1例行根治性手术，其它均行功能性手术，对喉、气管、食管及下咽的缺损进行了修复重建。全部病例均有1年以上的随访。结果发现，11例喉气管重建者均拔管；2例下咽食管成形者吞咽功能良好。1例术后4年双肺转移死亡，余15例未发现复发及转移。其中生存1年、3年、5年、10年和15年者分别为16例、14例、7例、3例和1例。探讨了晚期甲状腺癌腺外浸润范围对确定手术方式的意义及术后综合治疗的重要性。尽管晚期病变腺外浸润周围诸多重要器官和结构，但积极行功能性外科手术仍有助于提高疗效及患者生存质量。

This retrospective study was undertaken to evaluate surgical resultand prognosis of the advanced thyroid carcinoma with extrathyroidal invasion. Sixteencases were investigated that the lesions invaded areas including the trachea,esophagus, larynx,laryngeal recurrent nerve, hypopharynx,and main cervical blood vessels.One case had radical resection, fifteen cases had functional operation which reconstructed for larynx, trachea, and esophagus by versaticle technigues. All these caseswere followed up 1 year later. Results showed that 11 cases of laryngotrachea reconstruction were decannulated,2 cases of hypopharyngo-esophageal plasty had not anastomasis structure with good swallow function. One case developed lung metastasis anddied 5 years later,others had no recurrence or metastasis. The cases that survived 1,3, 5, 10 and 15 year were 16, 14, 7, 3 and I respectively. The importance of the invadedarea to surgical methods and the combined therapy were discussed. Although the advanced thyroid carcinoma invaded surrounding structures, the effective functionalsurgery should be to improve the results and the life quality of the patients.[Chinese Arch Otolaryngol Head Neck Surg, 1999; 6 (2): 103~ 106From the Department of Otolaryngology, Affiliated Hospital of Shandong MedicalUniversity,Jinan 250012 (Dr. Guan Fangxia)]