| 摘要: |
| 目的:探讨甲状腺癌累及喉、气管、食管、下咽时的外科处理。方法:对17例伴有喉、气管、食管、下咽受累的分化型甲状腺癌患者行一期肿瘤切除。17例患者均有喉气管受累,其中14例分别行肿瘤削除术、气管楔形切除缝合术、气管窗状切除胸锁乳突肌肌骨膜瓣修复术、气管袖状切除端端吻合术、气管袖状切除游离前臂皮瓣气管重建术；3例行喉全切或近全切除术。伴有食管、下咽受累者11例分别行肌层切除或食管部分切除胸大肌肌皮瓣修复术。伴有喉返神经受累者12例行喉返神经松解术、喉返神经切除一期杓状软骨内收术和(或)颈袢喉返神经修复术9例,单纯喉切除术3例。结果:17例患者术后随访1~12年,5年生存率93.3％,手术并发症发生率23.5％。行肿瘤削除术及气管部分切除术各有1例复发,其余术后均无局部复发。喉返神经松解或行相关发音重建的9例患者术后嗓音均有明显改善,其中5例恢复正常。结论:累及喉、气管、食管、下咽的分化型甲状腺癌仍可手术切除并行功能重建以提高治愈率,改善生活质量；手术方法的选择依赖于肿瘤侵犯的部位、范围、喉返神经浸润的程度与病程；手术创伤大,修复重建较复杂,并发症发生率较高。 |
| 关键词: 甲状腺肿瘤 喉 气管 食管 外科治疗 |
| DOI：10.3724/SP.J.1008.2008.00 |
| 投稿时间：2008-07-09修订日期：2008-09-08 |
| 基金项目:国家自然科学基金(30672295). |
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| Surgical treatment for well-differentiated thyroid carcinoma invading the larynx,trachea,esophagus and hypopharynx |
| LIU Fei,ZHENG Hong-liang,CHEN Shi-cai*,JING Jian-jun,CHEN Dong-hui,CHEN Gang,WANG Wei,ZHU Min-hui,SHI Jian-bin |
| (Department of Otolaryngology & Head and Neck Surgery,Changhai Hospital,Second Military Medical University,Shanghai 200433,China) |
| Abstract: |
| Objective:To explore the surgical treatment for well-differentiated thyroid carcinoma（WDTC） invading the larynx,trachea,esophagus and hypopharynx. Methods: Primary tumor resection was performed in 17 patients with advanced WDTC．All the 17 cases had laryngotracheal involvement and received different kinds of surgical treatment: including 14 receiving local shaving-off,wedge tracheal resection with direct suture,window tracheal resection with sternocleidomastoid myoperiosteous flap reconstruction,sleeve tracheal resection with tracheal anastomosis or tracheal reconstruction by forearm free skin flap,and 3 receiving total laryngectomy or near-total laryngectomy. Eleven cases with esophagus and hypopharynx involvement received muscular layer resection or esophageal and hypopharynx partial resection with pectoralis major myocutaneous flap reconstruction. For 12 cases with recurrent laryngeal nerve involvement,9 were treated by nerve decompression,nerve resection combined with one-stage arytenoid within-shift and/or recurrent laryngeal nerve transposition,3 by simple laryngectomy. Results: The patients were followed up for 1 to 12 years. Sixteen patients survived and one died of tumor metastasis. The 5-year survival rate was 93.3%; the post-operation complication rate was 23.5％.Tumor relapses were found in 2 cases who had undergone local shaving-off or partial cervical trachea resection. The voice quality of the 9 patients receiving recurrent laryngeal nerve decompression or voice rehabilitation was greatly improved,and 5 of them had normal voice. Conclusion: The curative rate and quality of life of WDTC patients with extrathyroidal extension can be improved by one-stage resection and reconstruction. Operation modes should be chosen according to the location, involvement of tumor, the invasion of recurrent laryngeal nerve and the disease course. Operation is invasive and reconstruction is a complicated process, with many complications. |
| Key words: thyroid neoplasms larynx trachea esophagus surgical therapy |
