分化型甲状腺癌侵入气管内的外科治疗及气道重建

Surgical treatment and tracheal reconstruction of differentiated thyroid carcinoma with intraluminal tracheal invasion

目的探讨分化型甲状腺癌侵入气管内的外科治疗方法及效果。方法回顾性分析分化型甲状腺癌侵入气管内的患者行气管袖状切除术后的治疗结果。16例分化型甲状腺癌(均为乳头状癌)侵入气管内的患者进行了颈部淋巴结清扫术+肿瘤整块切除术及气管袖状切除术,并一期行气管端端吻合术重建气道。结果 16例患者手术均成功进行,术后并发症发生率为12.5%(2/16),其中气管吻合口狭窄1例,CO2激光加浅层放疗治愈;双侧声带麻痹1例,CO2激光切除一侧声带后分治愈。平均随访时间23个月,1例患者术后3个月出现局部淋巴结复发,再次术后带瘤生存;1例局部复发死亡。结论气管袖状切除-拉拢缝合术能有效治疗分化型甲状腺癌侵犯气管内,而CO2激光与浅层放疗对术后双侧声带麻痹及吻合口瘢痕增生是有效的。

Objective To investigate the effect of tracheal sleeve resection in papillary thyroid cancer with tracheal invasion. Methods The outcome of tracheal sleeve resection in patients with thyroid cancer and tracheal invasion were retrospectively analyzed. Sixteen patients with papillary thyroid carcinoma and tracheal invasion underwent neck dissection, tumor en bloc resection, and tracheal sleeve resection followed by end-to-end anastomosis. Results The mobidity of postoperative complication was 12.5%. Tracheal anastomotie stenosis occurred in one patient, and was treated with laser CO2 and radiotherapy. Bilateral recurrent laryngeal nerve paralysis occurred in one patient postoperatively, and laser CO2 with bilaterat posterior cordectomy was done. The median length of follow-up was 23 months. One patient displayed a regional lymph node recurrence and required further surgery 3 months after surgery, one patient died of local recurrence. Conclusion Tracheal sleeve resection is appropriate for the management of patients with papillary thyroid carcinoma and intraluminal tracheal invasion, and laser CO2 and/or radiotherapy are available to deal with bilateral recurrent laryngeal nerve paralysis and anastomotic restenosis.