侵犯气管的分化型甲状腺癌的外科处理及预后分析

Management and prognosis of differentiated thyroid carcinoma with tracheal invasion

目的 探讨分化型甲状腺癌侵犯气管的治疗方法及其预后.方法 回顾性分析1990年1月至1998年6月期间50例甲状腺乳头状癌及滤泡状癌侵犯气管患者的临床资料.根据肿瘤侵犯气管的范围和程度选择不同的手术方法.A组：肿瘤锐性削切手术（20例）;B组：肿瘤切除及气管壁袖状切除或气管壁部分切除气管重建术（23例）;C组：肿瘤切除、气管部分切除及喉全切除术/喉腔封闭术（7例）.38例患者术后行131I治疗.采用Kaplan-Meier法计算生存率.结果 随访时间15 ～22年,其中2例失访.患者总的5年、10年、15年生存率分别为90.0％、74.0％、56.0％.38例患者术后行131I治疗,5年、10年、15年生存率分别为94.7％、81.6％、65.8％,12例患者术后未行131I治疗,5年、10年、15年生存率分别为75.0％、50.0％、25.0％;术后是否行131I治疗5年（P =0.044）、10年（P=0.018）、15年（P =0.002）生存率比较,差异有统计学意义.结论 根据分化型甲状腺癌侵犯气管的程度不同选择不同的手术方式可以达到治疗肿瘤的目的.统计表明术后行131I治疗可提高分化甲状腺癌侵犯气管患者的生存率.

Objective To evaluate treatment modalities and prognosis differentiated thyroid carcinoma （DTC） with tracheal invasion.Methods Clinical data were reviewed and analyzed in 50 patients treated for DTC with tracheal invasion between January 1990 and June 1998.The different surgical modalities were applied according to the extent of tracheal invasion：shave excision （20 cases）,tracheal sleeve resection or tracheal partial resection （23 cases）,total laryngectomy or laryngeal closure surgery （7 cases）.Thirty-eight cases received postoperative 131I therapy.Survival rate was evaluated using the Kaplan-Meier analysis.Results The 5-,10-and 15-year survival rates of all the cases were 90.0%,74.0% and 56.0%,respectively.The 5-,10-and 15-year survival rates were 94.7%,81.6% and 65.8% respectively in 38 cases with postoperative 131 I therapy and were 75.0%,50.0% and 25.0% respectively in 12 cases without postoperative 131I therapy,with statistically significant differences in 5-,10-or 15-year survival rates between the patients of two groups.Conclusions The tumors can be resected radically by corresponding surgery based on the extent of tracheal invasion.Postoperative 131I therapy can enhance the survival rate of the patients with differentiated thyroid carcinoma involving in trachea.