甲状腺癌侵犯气管的外科治疗

Surgical Treatment of Well Differentiated Thyroid Carcinoma Invading Tracheal

目的探讨分化型甲状腺癌（well differentiated thyroid carcinoma,WDTC）侵犯气管的外科治疗方法及其临床意义。方法回顾性分析2001年1月至2012年10月期间收治的40例WDTC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：肿瘤锐性削除手术（25例）;B组：根治性手术切除（气管窗式切除8例、全喉切除4例）;C组：姑息性切除3例。术后辅助核素治疗及内分泌治疗。采用Kaplan-Meier法计算生存率。结果全组随访时间5~10年,其中2例失访。A、B、C三组患者总的5年生存率分别为92%、91.6%、33.3%,A组与B组10年总生存率分别为80%、71.4%。接受根治性手术＋气管窗式切除的患者,均在术后6个月内拔除气管套管,未出现气管狭窄等明显并发症,生存质量良好,其中1例患者在术后第3年出现肺部转移,目前带瘤存活。全喉切除患者,1例在术后出现咽漏,经换药治疗后好转。A组与B组生存率比较,χ2=0.194,P=0.659,差异无统计学意义;A组与C组生存率比较,χ2=26.890,P=0.000,差异有统计学意义;B组与C组生存率比较,χ2=14.504,P=0.000,差异有统计学意义,C组的生存率明显下降。结论对侵犯气管的WDTC患者,应根据肿瘤侵犯气管范围的不同,选择相应的手术方式,但都应在尽量保留功能的前提下切除所有肿瘤病变和受累组织器官。

Objective To evaluate different surgical procedures and the clinical significance of well dif- ferentiated thyroid carcinoma（WDTC） with tracheal invasion. Methods Clinical data were reviewed and an- alyzed in 40 patients treated for WDTC with tracheal invasion from January 2001 to October 2012. Different sur- gical treatments were applied according to the extent of tracheal invasion, in which group A was shave excision （25 cases）, group B was radical surgery including tracheal window resection（ 8 cases） and total laryngeetomy （4 cases） and group C was incomplete tumor resection （3 cases）. These patients received radionuelide therapy and endocrine therapy after surgery. Survival rate was evaluated using the Kaplan-Meier analysis. Results The overall 5-year survival rate was 92% ,91.6% and 33.3% in group A,B and C respectively. The overall 10-year survival rate was 80% and 71.4% of group A and B. All the patients who received tracheal window re- section got the tracheal tube removed within six months after operation without complication. One patient had lung metastasis 3 years after operation, and was currently alive with tumor. One of the total laryngectomy pa- tients appeared pharyngeal leak and got better after dressing change. The difference of survival rate in group A n 2 and B was ot stausucally slgnlficant（x2= 0. 194 ,P = 0.659）. But it significantly decreased in group C compa- ring with group A （X2 = 26. 890, P = 0. 000） and group B （X2 = 14. 504, P = 0.000）. Conclusion A more aggressive surgical treatment should be taken in well differentiated thyroid cancer patients with tracheal in- vasion. The appropriate surgical approach should be selected to reduce the recurrence according to the tra- chea range of different tumor invasion. All the tumor lesions and organs should be removed in the premise of function preservation.