分化型甲状腺癌侵犯喉气管临床分析

Clinical analysis of surgical management of Welldifferentiated thyroid carcinoma ivading larynx and trachea

目的探讨甲状腺癌累及喉、气管时的外科处理方法。方法 2000年1月~2010年12月在我院手术治疗晚期分化型甲状腺癌24例,根据肿瘤侵犯喉、颈段气管的范围及程度分别行肿瘤削除术和气管袖状切除端端吻合术;喉部分切除胸锁乳突肌或颈阔肌皮瓣修复术。结果 24例患者均接受根治性手术切除,喉、气管缺损修复重建。术式：肿瘤削除术8例,气管袖状切除8例,喉部分切除术8例。吻合方式：气管端端吻合8例,胸锁乳突肌皮瓣修复4例,颈阔肌皮瓣修复4例。本组患者肿瘤复发率为8.3%,5年累积生存率为91.6%。结论对侵犯喉、气管的分化型甲状腺癌患者应采取更为积极的外科治疗,以减少术后复发,提高生存率。

OBJECTIVE To study the surgical treatment for well-differentiated thyroid carcinoma（WDTC） invading the larynx and trache a. METHODS A retrospective analysis was made in 24 cases with WDTC invading the larynx and trachea in Jinlin Tumor Hospital from 2000 to 2010. Twenty-four cases of well differentiated thyroid carcinoma with laryngotracheal invasion were treated by different kinds of surgical modalities including tumor excision surgery,the trachea sleeve resection with end-toend anastomosis, partial laryngectomy, sternocleidomastoid muscle or platysma myocutaneous f lap repair. Some patients received postoperative radiotherapy. The data were statistically analyzed for survival rates according to the Kaplan-Meier method. RESULTS Twenty-four cases underwent radical resection and the defect of larynx-trachea were reconstructed. Excision of the tumor on the trachea, tracheal sleeve resection and partial laryngectomy were performed. The defect were repaired with tracheal anastomosis in 8 cases, sternocleidomastoid flaps in 4 cases, and platysma myocutaneous flap in another 4 cases. The recurrence rate was 8.3%. The 5 year survival rate was 91.6%. CONCLUSION Active surgical management and postoperative adjunctive radiotherapy were effective in treatment of patients with advanced differentiated thyroid carcinoma.