摘要
背景与目的:手术是治疗侵犯气管的局部晚期甲状腺癌的首选方法。根据侵犯气管位置和程度的不同,其处理方法也不尽相同。选择合适的治疗方式对患者的预后和生活质量尤为重要。通常甲状腺癌气管侵犯时已伴有颈淋巴结转移、颈部大血管粘连,甚至食管和喉的侵犯,因其解剖结构复杂多变,目前仍没有高级别的循证医学证据指导治疗。本文旨在探讨侵犯气管的局部晚期甲状腺癌的临床特点和外科处理方法。方法:回顾2019年7月—2021年7月重庆大学附属肿瘤医院头颈肿瘤中心诊治的20例侵犯气管的局部晚期甲状腺癌患者资料,其中,男16例,女4例;年龄13~78岁,中位年龄53.5岁;甲状腺滤泡癌2例,髓样癌2例,甲状腺乳头状癌16例;3例锐性削除受侵气管外壁,5例行局部气管窗式切除术,10例行气管袖式切除+端端吻合术,1例行全喉切除+气管永久造瘘,1例行全喉切除+永久气管造瘘+胸大肌皮瓣修复,术后均接受131I治疗或分子靶向药物的综合治疗。结果:患者随访时间4个月至2年不等。3例锐性削除受侵气管外壁患者未见肿瘤复发,无气管瘘;5例行气管窗式切除患者均Ⅰ期缝合气管创面;10例气管袖式切除+端端吻合患者均未出现气道狭窄和双侧声带麻痹,其中1例出现术后局部感染和局部气管瘘口,换药后愈合;1例同时侵犯喉行全喉切除+气管永久造瘘,1例同时侵犯喉和颈部皮肤行全喉切除+永久气管造瘘+胸大肌皮瓣修复,后2例患者带管生存。截止投稿时本文纳入患者未出现肿瘤进展情况。结论:颈段气管的切除和修复是外科医生常常需要面对和处理的难题,笔者的治疗原则是在病灶可完整切除和患者能耐受的前提下,尽可能选择外科手术治疗。对于侵犯气管及其邻近器官的局部晚期甲状腺癌患者,应在MDT讨论指导下制定治疗方案,术前进行充分的方案准备和应对并发症的措施。�
Background and Aims:Surgery is the preferred treatment for locally advanced thyroid cancer that invades the trachea.According to the location and degree of trachea invasion,the treatment methods are varied.Appropriate treatment choice is crucial for patients'prognosis and quality of life.Usually,tracheal invasion of thyroid cancer is accompanied by lymph node metastasis,adhesion of vessels,and even invasion of esophagus and larynx.Due to its complex and variable anatomical structure,there are still no high-level evidence-based medical recommendations to guide the treatment.This study was designated to investigate the clinical features and surgical management of locally advanced thyroid carcinoma with tracheal invasion.Methods:The data of 20 patients with locally advanced thyroid cancer and accompanying tracheal invasion from July 2019 to July 2021 were reviewed.Of the patients,16 cases were males,and 4 cases were females,aged from 13 to 78 years with a median age of 53.5 years;there were 2 cases of thyroid follicular carcinoma,2 cases of medullary carcinoma and 16 cases of thyroid papillary carcinoma;three cases underwent shave resection for superficial tracheal invasion,5 cases underwent window resection for tracheal mucosal and luminal invasion,10 cases underwent tracheal sleeve resection and end-to-end anastomosis,one case underwent total laryngectomy and trachea permanent tracheostomy,one case underwent total laryngectomy and permanent tracheostomy with pectoralis major myocutaneous flap repair.All patients received systemic treatment,including radioiodine therapy or molecular targeted therapy.Results:The follow-up time of the patients ranged from 4 months to 2 years.No tumor recurrence or tracheal fistula was found in the 3 patients undergoing tracheal shave excision;all 5 patients receiving tracheal window resection had phase I tracheal repair with tracheal wound suture;no airway stenosis or bilateral vocal cord paralysis occurred in the 10 patients undergoing sleeve resection and end-to-end anastomosis,of
作者
张俊斌
张玉莲
汤喜
龚靖淋
张成瑶
ZHANG Junbin;ZHANG Yulian;TANG Xi;GONG Jinglin;ZHANG Chengyao(Center for Head and Neck Cancer,Chongqing University Cancer Hospital,Chongqing 400030,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2022年第11期1453-1461,共9页
China Journal of General Surgery
基金
中国抗癌协会肿瘤研究青年科学基金资助项目(CAYC18A49)
重庆市科研院所绩效激励引导专项基金资助项目(cstc2017jxjl130022)
北京市希思科临床肿瘤学研究基金会希思科-朝阳肿瘤研究基金资助项目(Y-Young2021-0071)
重庆市自然科学基金面上资助项目(cstc2021jcyj-msxmX0498)。
关键词
甲状腺肿瘤
头颈部肿瘤
肿瘤浸润
气管
Thyroid Neoplasms
Head and Neck Neoplasms
Neoplasm Invasiveness
Trachea
