高分化甲状腺癌侵犯喉气管的治疗及预后

目的探讨高分化甲状腺癌(DTC)喉气管受侵的治疗及预后.方法回顾性分析1976～1996年间86例DTC侵犯喉气管的患者资料.根据肿瘤侵犯喉气管的范围和程度不同分别行肿瘤削除术39例、根治性切除21例(气管窗式切除11例、气管袖状切除8例和全喉切除2例)和姑息性切除26例.部分患者术后补充放疗.生存率比较采用Kaplan-Meier法.结果① 39例喉气管局限性受侵行肿瘤削除术者,5年和10年生存率分别为92.3%(36/39) 和75.9% (22/29).术后放疗9例,术后未放疗30例.对于肿瘤削除术患者, 术后放疗与术后未放疗,其5年和10年生存率差异均无显著性(P>0.05).② 21例肿瘤侵及喉气管腔内行根治性切除者,5年和10年生存率分别为85.7% (18/21) 和53.9% (7/13).术后放疗11例,术后未放疗10例.对于肿瘤侵及喉气管腔内行根治性切除者,术后放疗与术后未放疗,其5年和10年生存率差异均无显著性(P>0.05).③26例姑息切除患者,5年和10年生存率分别为50.0% (13/26) 和19.2% (5/26).9例术后放疗患者,5年和10年生存率分别为77.8%(7/9) 和55.6% (5/9).17例术后未放疗患者,5年生存率为35.3%(6/17),随访10年无生存者.对于姑息切除组,术后放疗比术后未放疗患者10年生存率明显提高,两者差异有显著性(P<0.01).结论 DTC喉气管受侵尚未侵及腔内黏膜层者可采用肿瘤削除术得以根治.穿透喉气管腔内黏膜层者应行肿瘤根治性切除以避免窒息等并发症的发生,延长患者的生存.术后放疗对于肉眼根治者疗效并不肯定,但可明显提高姑息性切除患者的生存.

The management and prognosis of laryngotracheal invasion by well-differentiated thyroid carcinoma

OBJECTIVE: To explore the treatment and prognosis on patients with laryngotracheal invasion by well-differentiated thyroid carcinoma (DTC). METHODS: Eighty-six patients treated for DTC with laryngotracheal invasion between 1976 and 1996, from Beijing Chaoyang Hospital and Cancer Hospital, Chinese Academy of Medical Sciences, were retrospectively analyzed. The different kinds of surgical modalities were performed according to the extent of laryngotracheal invasion by DTC, including shave excision (39 cases), tracheal window resection (11 cases), circumferential sleeve resection (8 cases), total laryngectomy (2 cases) and incomplete tumor resection (26 cases). Some patients received postoperative radiotherapy. Survival was evaluated using the Kaplan-Meier method. RESULTS: (1) Thirty-nine patients with laryngotracheal invasion were treated with shave excision, the 5- and 10-year survival rates were 92.3% (36/39) and 75.9% (22/29), respectively. Nine patients received postoperative radiotherapy, 30 patients didn't received postoperative radiotherapy. After a shave excision, the differences of 5- and 10-year survival rates between the irradiated and nonirradiated patients were not statistically significant (P >0.05). (2) Twenty-one patients underwent radial excision for intraluminal involvement extending through the laryngotracheal cartilage, including circumferential sleeve resection, tracheal window resection and total laryngectomy, the survival rate was 85.7% (18/21) for five years and 53.9% (7/13) for ten years. Eleven patients received postoperative radiotherapy, 10 patients didn't received postoperative radiotherapy. After a radial excision, the differences of 5- and 10-year survival rates between underwent irradiated and nonirradiated patients were not statistically significant (P >0.05). (3) For the 26 patients receiving the incomplete resection, the 5- and 10-year survival rates were 50.0% (13/26) and 19.2% (5/26), respectively. For 9 patients receiving postoperative radiotherapy, the 5- and 10-year survival rates were 77.8% (7/9) and 55.6% (5/9), respectively. 17 patients did not received postoperative radiotherapy, the 5-year survival rate was 35.5% (6/17). No patient survived for ten years. CONCLUSION: Tumors with minimal invasion could be treated successfully by shaving tumor from the aerodigestive tract. Intraluminal involvement extending through the laryngotracheal cartilage should be resected completely to prevent complications, such as airway hemorrhage or suffocation, and markedly improve the survival for patients with invasive DTC.