支气管镜介入技术在甲状腺癌侵犯气管治疗中的应用

The Application of Bronchoscopic Modalities for Trachea Invasion by Thyroid Cancer

目的评价经支气管镜介入治疗甲状腺癌侵犯气管的临床效果、并发症及预后。方法回顾性分析长海医院呼吸内科自2006年1月至2015年9月收治的43例甲状腺癌侵犯气管患者的临床资料。根据甲状腺癌侵犯气管的类型、狭窄程度、基底部情况的不同采用高频电刀、氩气刀、激光、冷冻、支架置入及放射性粒子植入进行治疗。比较介入治疗前后的气管直径、气促指数,观察介入治疗中和治疗后的并发症。结果 43例甲状腺癌侵犯气管的患者经支气管镜介入治疗,病变部位气管直径由(3.9±1.5)mm增加到(10.6±0.6)mm(t=-17.314,P<0.000 1),气促指数由(3.3±0.7)分降低到(2.3±0.7)分(t=9.274,P<0.000 1)。术中并发症包括出血(46.5%)、声带活动受限(4.7%)和声门水肿(7.0%)。支架置入的患者再狭窄发生率为26.7%。37例随访成功的患者治疗后中位生存期为27个月。经单因素及多因素分析,使用介入方法的种类为预后的独立危险因素(HR=0.261,P=0.036)。使用≥3种方法治疗的中位生存期为47个月,使用2种方法治疗的中位生存期为36个月,使用1种方法治疗的中位生存期为13个月。结论对甲状腺癌侵犯气管,经支气管镜介入治疗可以有效解除气道阻塞,改善气促症状;使用多种介入方法联合治疗预后较好。

Objective To assess the efficiency,safety and long-term prognosis for interventional bronchoscopy in the treatment of trachea invasion by thyroid cancer. Methods The clinical data of fortythree patients with trachea invasion by thyroid cancer in Changhai Hospital from January 2006 to September2015 were retrospectively analyzed. The trachea diameter and dyspnea score were compared before and after interventional treatment to explore the efficiency. The complications during and after therapy were observed.All patients were treated with interventional modalities including electrocautery,argon plasma coagulation,laser,cryotherapy,stent insertion or radioactive seeds implantation according to different invasion types,degree of stenosis and base situation. Results The trachea diameter increased from（ 3. 9 ± 1. 5） mm to（ 10. 6 ± 0. 6） mm after bronchoscopy therapy（ t =- 17. 314,P〈 0. 000 1）. The dyspnea score decreased from 3. 3 ± 0. 7 to 2. 3 ± 0. 7 after bronchoscopy therapy（ t = 9. 274,P〈 0. 000 1）. The complications during therapy included haemorrhage（ 46. 5%）,vocal cord paralysis（ 4. 7%） and glottis edema（ 7. 0%）.The restenosis rate in the patients with stent insertion was 26. 7%. Thirty-seven patients were followed up successfully,and the medium survival time for follow-up patients was 27 months. The univariate and multivariate analysis indicated that the kind of interventional modalities used for therapy was an independent prognostic factor of survival（ HR = 0. 261,P = 0. 036）. The medium survival time for the patients treated with ≥3 methods,2 methods and 1 method was 47 months,36 months and 13 months,respectively.Conclusions For trachea invasion by thyroid cancer,bronchoscopic therapy can effectively relieve airway obstruction and dyspnea symptom. Combination of multiple interventional modalities could have a favorable prognosis after treatment.