累及喉、气管的甲状腺乳头状癌临床治疗分析

Clinical analysis of malignant thyroid tumors with laryngotracheal invasion

目的探讨累及喉、气管的甲状腺乳头状癌的临床治疗经验。方法回顾性分析2010年1月至2019年12月山东大学齐鲁医院耳鼻咽喉科收治的87例累及喉、气管的甲状腺乳头状癌患者的基本资料,统计分析其采用的肿瘤切除方式、气管修补方法、术后拔管率及3年和5年生存率。结果87例患者均进行了手术治疗,肿瘤切除方式包括:气管壁肿瘤锐性剃除(60例),气管壁楔形切除(15例),气管袖状切除(3例),喉部分切除(1例),全喉切除(4例),姑息切除(4例)。气道重建方法包括:拉拢缝合(5例),胸大肌肌皮瓣修补(1例),胸锁乳突肌锁骨骨膜瓣修补(1例),端端吻合(3例),喉成型术(1例),气管造瘘术(12例)。随访时间为4-122个月,随访到79例,其中15例行气管切开,气管切开术后拔管率66.7%(10/15),3年生存率为100%,5年生存率为93.0%。结论对于累及喉、气管的甲状腺乳头状癌,通过准确的术前评估和合理的手术治疗,可以显著改善患者生活质量,获得良好的生存期。

Objective To explore the clinical treatment outcomes in thyroid papillary carcinoma patients with laryngotracheal invasion.Methods The study involved 87 patients with papillary thyroid carcinomas involving the larynx and trachea who reported to the Department of Otolaryngology at the Qilu Hospital of Shandong University between January 2010 and December 2019.Their basic demographic data,tumor resection procedures,tracheal repair procedures,postoperative extubation rate,and 3-year and 5-year survival rates were retrospectively analyzed.Results All the 87 patients were treated surgically.Tumor resection procedures included sharp shaving of the tracheal wall tumor(60 cases),tracheal wall wedge resection(15 cases),tracheal sleeve resection(3 cases),partial laryngectomy(1 case),total laryngectomy(4 cases),and palliative resection(4 cases).Airway reconstruction procedures included,suturing(5 cases),pectoralis major muscle flap repair(1 case),sternocleidomastoid clavicle periosteum flap repair(1 case),end-to-end anastomosis(3 cases),laryngoplasty(1 case),and tracheostomy(12 cases).Seventy-nine patients were followed for 4–122 months,of which 15 patients underwent tracheotomy,with an extubation rate of 66.7%(10 out of 15 patients).The 3-year and 5-year survival rates were 100%and 93.0%,respectively.Conclusion Accurate preoperative evaluation and reasonable surgical treatment may significantly improve the quality of life and facilitate the satisfactory survival of patients with thyroid papillary carcinoma involving the larynx and trachea.