甲状腺癌合并呼吸困难的处理

Management of Thyroid Cancer with Respiratory Embarrassment Due to involvement of Trachea

1980～1988年共治疗甲状腺癌合并呼吸困难10例,手术切除8例,切除率80％,无手术死亡。因纵隔广泛受累,仅切检后放、化疗和术中探查,发现癌块包绕颈动脉,未能切除,仅切检并狭窄平面下气管切开各1例,切除例剔除气管受累处:气管壁洞穿性缺损直径0.5cm 3例,均行气管造口;气管后间隙残留癌灶行狭窄平面下气管切开1例。切除例中,5例术后分别健在6年,5年半、5年、3年和1年半;2例于术后1、2年内死亡;1例2年后失访。未切除2例中,1例带瘤生存6月,另1例6月后死亡。提倡在无手术禁忌情况下争取较彻底切除。

During 1980-1988, 10 cases of thyroid cancer with involvement of trachea were treated. These account for 5.5% of the total thyroid cancers seen in the same period of time. Histologically, 6 cases were anaplastic carcinoma and 4 well differentiated. Radioal resection was performed in 8 cases, and tracheotomy was done in 3 of them because the latter had defect of tracheal wall larger than 0.5 cm in diameter. Owing to extensive involvement of mediastinum, tracheotomy was done only and followed by postopertive irradiation or chemotherapy in 1 each case. There was no operative mortality. In eight resected cases, five have been surviving for 6, 5.5, 5, 3 and 1.5 years respectively, another two died in 1 and 2 years after surgery, and one other was lost to follow-up. In two of the non-resectable cases, one is still alive with cancer for 6 months, one died in 6 months. The author pointed out that radical resection should be done for thyroid cancer with involvement of trachea in the absence of serious contraindication.