累及喉气管的晚期甲状腺癌一期手术整复

One stage reconstruction of larynx and cervical trachea involvedby advanced thyroid carcinoma

目的 :探讨晚期甲状腺癌累及喉、气管时的一期手术整复方法。方法 :对 18例存在喉气管受累的晚期甲状腺癌患者进行一期肿瘤全切及喉气管整复 ,其中 7例喉受累患者全喉切除 3例 ,喉部分切除 4例 ;18例颈段气管受累患者中 ,8例直接切除肿瘤 ,10例切除受累气管壁后 ,修复方法包括 :拉拢缝合 1例、端端吻合 3例、带蒂胸锁乳突肌骨膜瓣 2例、岛状胸大肌肌皮瓣 3例和颈部皮瓣 1例。结果 :住院期间肿瘤复发死亡 1例。除 3例全喉切除患者外 ,14例成功保留喉功能 ,其中拔除气管套管 8例 ,堵管 2例 ,继续带管 4例。结论 :对于累及喉气管的晚期甲状腺癌采用一期手术切除并整复不仅切实可行 ,而且可以提高此类患者的治愈机会 。

Objective:To investigate clinical prognosis and the one-stage methods of reconstruction for advanced thyroid carcinoma while larynx and cervical trachea involved.Method:One-stage resection and laryngotracheal reconstruction were performed in 18 advanced thyroid carcinomas. Among them, total laryngectomy were performed in 3 cases and partial laryngecomy in the other 4 larynx-involved cases. Cervical trachea involvement were found in all 18 cases. Besides 8 shave-off of tumor, area of trachea invaded by carcinoma were removed in other 10 cases. The methods applied for the tracheal reconstruction were 1 simple suture, 3 tracheal anastomosis, 2 pedicled sternocleidomastoid myoperiosteous flap, 3 insular myocutaneous pectoralis major flap and 1 cervical flap.Result:One patient died of cancer reoccurrence while in the hospitalization. Except for 3 cases with total laryngectomy, larynx preservation were done in 14 cases and tracheal cannula were pulled out in 8, blocked in 2 and kept carrying in 4 cases.Conclusion:One stage reconstruction of larynx and cervical trachea involved by advanced thyroid carcinoma is feasible and practical. Curative rate, survival time and life quality all can be improved.