累及喉、气管的甲状腺乳头状癌的手术治疗分析

Surgical treatment of papillary thyroid carcinoma involving larynx and trachea

目的总结累及喉、气管的甲状腺乳头状癌(PTC)患者的手术治疗效果。方法回顾性分析2004—2019年山东大学齐鲁医院耳鼻咽喉科收治的甲状腺恶性肿瘤病例1436例,筛选出累及喉、气管的PTC患者110例,其中随访资料完整者105例。男性42例,女性63例,男女比例为1∶1.5,年龄28~81岁。病变均侵犯气管,其中11例亦侵犯喉。术式方面行喉、气管壁肿瘤削除术83例,行肿瘤根治性切除+喉、气管修复22例。统计患者基本情况、拔管率,采用Kaplan-Meier法分析患者术后生存曲线。结果105例患者中行气管切开术16例,12例顺利拔管。患者3年、5年、10年总体生存率为100.0%、86.4%、72.5%,无瘤生存率分别为93.1%、81.6%、57.7%,2组生存曲线比较差异有统计学意义(χ^(2)=4.21,P=0.040)。喉、气管壁肿瘤削除组5年、10年生存率为94.6%、77.3%,肿瘤根治性切除组为85.7%、51.4%,2组间生存曲线比较差异无统计学意义(χ^(2)=3.50,P=0.061)。结论对于累及喉、气管的PTC患者,通过合理的手术治疗,可以获得较长的生存期和较高的生活质量。

Objective To evaluate the efficacy of surgical treatment of papillary thyroid carcinoma(PTC)involving larynx and trachea.Methods A total of 1436 cases of thyroid malignant tumors were admitted to the Department of Otolaryngology,Qilu Hospital of Shandong University from 2004 to 2019,including 110 cases of PTC involving larynx and trachea,and of which 105 cases with complete follow-up data were retrospectively analyzed.There were 42 males and 63 females,with a male/female ratio of 1∶1.5,aged from 28 to 81 years.All lesions involved trachea,including 11 cases involving both trachea and larynx.Of those 83 cases underwent laryngeal and airway wall tumor excision,and 22 cases underwent radical tumor excision plus laryngeal and trachea repair.Extubation rate was analyzed and the postoperative survival curve of patients was analyzed by Kaplan-Meier method.Results Among 105 cases,16 cases underwent tracheotomy and 12 cases were successfully extubated.The overall 3-5-and 10-year survival rates were 100.0%,86.4%and 72.5%,and the disease-free survival rates were 93.1%,81.6%and 57.7%,respectively.There was significant difference in survival curve between the two groups(χ^(2)=4.21,P=0.040).The 5-year and 10-year survival rates were 94.6%and 77.3%in laryngeal and tracheal tumor exclusion group,and 85.7%and 51.4%in the radical tumor resection group.There was no significant difference in the survival curves between the two groups(χ^(2)=3.50,P=0.061).Conclusion PTC patients with laryngeal and tracheal involvement can achieve long survival and good quality of life through reasonable surgical treatment.