甲状腺癌侵犯颈段气管的气管缺损与修复

Experience in tracheal defect repair for thyroid cancer with cervical trachea invasion

目的总结甲状腺癌侵犯颈段气管的气管缺损修复经验,提高术中气管缺损修复的治疗效果。方法收集2011年8月—2019年2月诊治的32例甲状腺癌侵犯颈段气管患者资料,其中6例术中采用锐性削除受侵气管外壁,8例气管袖式切除+端端吻合,6例胸锁乳突肌锁骨骨膜瓣,8例胸锁乳突肌锁骨骨膜瓣联合生物膜,2例前臂皮瓣+自体软骨移植,2例气管造瘘+Ⅱ期修复。结果6例锐性削除气管外壁患者中,有1例患者术后第6天出现气管瘘,予以换药后出院;余26例患者中,24例于术后6个月内恢复正常呼吸功能,1例前臂皮瓣+自体软骨移植患者术后出现局部气管狭窄,黏痰堵塞,带管生存,1例带蒂胸锁乳突肌骨膜瓣+生物膜患者术后气管局部塌陷伴双侧声带麻痹,带管生存。结论对于侵犯气管的甲状腺癌患者,根据不同的侵犯范围,选取合适的气管切除和缺损气管的修复方式,才能取得较高的手术成功率和较好的治疗效果。

Objective To summarize the experience in tracheal defect repair for thyroid cancer with cervical trachea invasion so as to improve the effect of intraoperative repair.Methods From Aug 2011 to Feb 2019,thirty-two patients suffering from thyroid cancer with cervical trachea invasion were surgically treated.Of them,6 cases received shave excision of the invaded outer wall of trachea,8 were treated with tracheal sleeve resection plus end-to-end anastomosis,6 with sternocleidomastoid clavicular periosteal flap,8 with sternocleidomastoid clavicular periosteal flap combined biofilm,2 with free forearm flap and autologous cartilage transplantation,and 2 with tracheal fistulization and phase II repair.Results Among the 6 patients with shave excision of tracheal outer wall,one got tracheal fistula on the 6th day after surgery and was discharged after dressing change.Of the remaining 26 patients,twenty-four(92.3%)completely restored their respiratory function in 6 months after surgery,extubation was not achieved in one patient with free forearm flap and autologous cartilage transplantation due to local tracheal stenosis and phlegm blockage,and another patient with sternocleidomastoid clavicular periosteal flap combined biofilm due to bilateral vocal cord paralysis and tracheal local collapse.Conclusion To obtain high surgical successful rate and good treatment effect,appropriate tracheal resection and proper repair method of tracheal defect should be selected based on the invasion range for the patients suffering from thyroid cancer with tracheal invasion.