高分化甲状腺癌侵犯喉气管的治疗

目的 探讨高分化甲状腺癌侵犯喉气管的临床特点及治疗，最大限度地提高患者的生存质量。方法 对49例高分化甲状腺癌侵犯喉气管患者分别行肿瘤削除术、喉气管部分切除胸锁乳突肌锁骨骨膜瓣修复术、气管袖状切除术、全喉部分气管切除术和姑息手术。部分患者术后补充放射治疗。术后随访3－20年，平均8年。结果 （1）23例局限性喉气管侵犯者行肿瘤削除术，肉眼切除干净的患者5年局部控制率达100％（12／12），显著高于少许残瘤患者50％（4／8）（P＝0．014）；（2）26例喉气管腔内侵犯者，行喉气管部分切除胸锁乳突肌锁骨骨膜瓣修复的7例患者中1例复发，9例行气管袖状切除术，2例行全喉部分气管切除术者均无复发；8例姑息手术患者的生存期较短。（3）除姑息手术患者，其他术后经放射治疗无复发。结论 根据高分化甲状腺癌侵犯的范围和程度，采取相应的术式，术后辅以放射治疗可达到切除癌肿、减少复发、保留喉气管功能和延长生存期的目的。

The management of laryngotracheal invasion by well-differentiated thyroid carcinoma

OBJECTIVE: To investigate the clinical characteristics and treament of well-differentiated thyroid carcinoma with laryngotracheal resection. METHODS: Forty-nine cases of well-differentiated thyroid carcinoma with laryngotracheal invasion were treated by different kinds of surgical modalities including local shaving-off, partial laryngotracheal resection with sternocleidomastoid myoperiosteal flap reconstruction, sleeve tracheal resection, total laryngectomy and incomplete tumor resection. Some patients received postoperative radiotherapy. The follow-up periods were 3-20 years with an average of 8 years. RESULTS: Twenty-two patients with local invasion were treated with shaving-off procedure, among which fifteen had their lesions removed completely with naked eyes and two relapsed postoperatively. Among the 8 cases with minor residual diseases four cases shoured postoperative relapse. Sixteen patients were treated with sleeve tracheal resection or partial laryngotracheal resection with stemocleidomastoid myoperiosteal flap reconstruction. Two patients were treated with total larygectomy among which only one relapse was found. The only postoperative complication was intratracheal granuloma formation which was found in three patients. The survival rate of the incomplete resection group was significantly lower than that of patients above mentioned. No local relapse was found in postoperative radiotherapy patients except in the patients of the incomplete resection group. CONCLUSION: According to the degree of invasion, adequate surgical procedure can obtain both cancer resection and organ preservation. Postoperative radiation may decrease relapse and prolong survival.