分化型甲状腺癌侵入气管内的外科治疗及气道重建

目的探讨分化型甲状腺癌侵入气管内的外科治疗方法及效果。方法回顾性分析分化型甲状腺癌侵入气管内的患者行气管袖状切除术后的治疗结果。16例分化型甲状腺癌（均为乳头状癌）侵入气管内的患者进行了颈部淋巴结清扫术＋肿瘤整块切除术及气管袖状切除术,并一期行气管端端吻合术重建气道。结果16例患者手术均成功进行,术后并发症发生率为12．5％（2／16）,其中气管吻合口狭窄1例,CO：激光加浅层放疗治愈;双侧声带麻痹1例,CO2激光切除一侧声带后分治愈。平均随访时间23个月,1例患者术后3个月出现局部淋巴结复发,再次术后带瘤生存;1例局部复发死亡。结论气管袖状切除一拉拢缝合术能有效治疗分化型甲状腺癌侵犯气管内,而CO2激光与浅层放疗对术后双侧声带麻痹及吻合口瘢痕增生是有效的。     

侵犯气管的甲状腺癌切除后锁骨头带蒂软骨修补术12例报告

目的探讨甲状腺癌侵犯气管的外科处理及预后。方法分析2001年1月至2005年12月对12例甲状腺癌侵犯气管2～4个软骨环,周径<50%的患者,行气管窗式切除后采用自体胸锁关节的锁骨头带骨膜肌瓣软骨修补气管缺损区的疗效。结果本组乳头状癌9例,滤泡状癌1例,髓样癌1例,B细胞淋巴瘤1例,均行甲状腺全切除术加患侧颈淋巴结清扫术。分化性甲状腺癌术后辅助Ⅰ治疗;B细胞淋巴瘤术后辅助化疗。术后半年纤维气管镜检查可见气管修补处已骨化,气管内黏膜拉网脱落细胞检查未找到癌细胞。全组随访6个月至4年,1例滤泡状癌于术后3年气管内局部肿瘤复发行气管镜下微波治疗和再次Ⅰ治疗后病情得到控制,仍然存活,其他病例无复发转移及死亡,生活质量较好。结论甲状腺癌侵犯气管采用前侧壁窗式切除结合自体带蒂软骨修补气管壁缺损是一种有效的治疗方法。     

甲状腺癌的规范化治疗

甲状腺癌规范化治疗是建立在对患者年龄、性别、肿瘤大小、肿瘤类型、有无颈部射线接触史、局部侵犯程度及有无远处转移等综合评价的基础之上. 一、分化性甲状腺癌 分化性甲状腺癌(DTC)包括乳头状癌、滤泡状癌,发病率分别占全部甲状腺癌的85%和10%.规范治疗应是以手术为主的综合治疗,包括手术、TSH抑制以及131I治疗.     

伴有呼吸道梗阻的晚期甲状腺恶性肿瘤的多学科协同处理

目的探讨多学科协同诊疗模式（MDT）在伴有呼吸道梗阻的局部晚期甲状腺恶性肿瘤治疗中的应用。 方法回顾性分析四川省肿瘤医院2015年10月至2017年7月收治的31例局部晚期甲状腺恶性肿瘤患者临床资料,其中伴有明显呼吸道梗阻症状（Shin分级Ⅳ级）13例。术前支气管镜及CT检查均明确诊断为肿瘤压迫或侵犯气管伴严重狭窄,所有患者术前经MDT讨论制定治疗方案,后期9例手术治疗,4例非手术治疗。 结果乳头状癌7例,乳头状癌合并鳞癌1例,低分化癌3例,未分化癌1例,淋巴瘤1例。根据2017年AJCC第8版临床肿瘤分期：Ⅲ期4例,Ⅳa期7例,Ⅳb期1例,淋巴瘤为Ⅳ期。患者呼吸困难症状均在急症气管支架置入后明显改善,9例限期完成手术,其中8例行甲状腺癌联合根治术及气管袖状切除一期气管重建,1例行甲状腺癌联合根治术及全喉、颈段及部分胸段气管切除、气管-胸骨柄低位造瘘。除1例患者术后第7天死于心肺功能衰竭外,7例气管切除端-端吻合重建者均一期愈合,无气管瘘发生。气管-胸骨柄低位造瘘者术后19 d出院。所有患者术后予以¹³¹I治疗和TSH抑制治疗。随访时间4~22个月,均无瘤生存。4例未手术治疗者中2例后期行局部放射治疗,生存期分别为1年及9个月;1例甲状腺淋巴瘤行化疗;1例未分化癌仅姑息对症治疗,生存期3个月。 结论晚期甲状腺恶性肿瘤侵犯气管导致的气道梗阻直接危及患者生命,MDT并拟定个体化诊疗方案具有显著优势。对于需要手术的患者,MDT模式的开展能显著减低围术期风险,提高生存率;对于无手术指征的患者,MDT可详细评估病情,制定对应的合理治疗方案,为患者姑息治疗提供机会,延长患者生命。     

分化型甲状腺癌淋巴结转移特点及颈侧方淋巴结清扫术局部应用解剖

分化型甲状腺癌是最常见的甲状腺癌,包括乳头状癌和滤泡状癌,多为低度恶性的甲状腺肿瘤,经过手术及术后辅助治疗后预后较好,可获得长期生存。有淋巴结转移者需要行颈淋巴结清扫是基本的外科治疗原则,但由于分化型甲状腺癌生物学行为的特殊性以及颈部解剖复杂,手术危险性相对较大,易发生意外损伤和并发症,目前国内外对分化型甲状腺癌颈部淋巴结清扫原则的认识仍未完全达成一致。     

甲状腺癌的放疗与化疗

甲状腺癌的处理除与病期有关外,病理诊断也是一个重要的参考依据。病理类型及分化程度不同,使肿瘤对放射线治疗的敏感度也有所不同。最敏感的为未分化癌,其余类型较差。分化性甲状腺癌(乳头状腺癌和滤泡状腺癌)应首先手术治疗。大部分病例由此已可根治,术后不必再常规做进一步放疗。此类肿瘤生长速度缓慢,即使已有部分远处转移仍可选用手术治疗。只是对于手术后有少量局部残留病灶或手术不能切除以及孤立性的远处转移病灶才选用外放射治疗。曾报告乳头状和滤泡状癌不能切除的病人外放射治疗的5年生存率为82%。未分化癌以外放射为主     

儿童甲状腺癌的临床特征及外科治疗

目的　探讨儿童甲状腺癌的临床特征、外科治疗和预后。方法　回顾性分析我院 1980～2 0 0 1年收治的 2 5例儿童甲状腺癌的临床资料。结果　全组均行手术治疗。 2 5例儿童甲状腺癌中 ,乳头状癌 17例 ,乳头状癌合并滤泡状分化者 3例 ,滤泡状癌 3例 ,髓样癌 1例 ,甲状腺纤维肉瘤 1例。术后随访时间 4个月至 18年 ,中位随访时间 6年。死亡 2例中 ,1例术中颈静脉角处有癌灶残留 ,术后 2年出现颈部淋巴结及肺部广泛转移而死亡 ,1例死于甲状腺纤维肉瘤复发。其余患儿均存活良好。结论　儿童甲状腺癌多为分化型肿瘤 ,且以乳头状癌多见 ,预后良好 ,手术是其主要治疗手段。即使对有局部复发或颈部淋巴结转移的病例 ,再次手术仍可获得良好效果。     

侵袭性分化型甲状腺癌的治疗及预后分析

目的 总结侵袭性分化型甲状腺癌的临床特征和治疗方法,探讨影响患者预后的因素.方法 回顾性分析中山大学肿瘤防治中心头颈外科1985年1月-1997年12月收治的114例侵袭性分化型甲状腺癌患者的临床病理资料,评价治疗效果,对生存状况与预后因素进行统计分析.生存分析采用Kaplan-Meier法和Log-Rank检验,多因素分析采用Cox比例风险模型.结果 初次治疗结束后,全组有68例带瘤生存(68/114,59.7%).全组患者的5年累积生存率为91.9%,10年累积生存率为80.1%,其中无肿瘤残留组、局部微小癌残留组和局部明显癌残留组的10年累积生存率分别为88.5%、78.5%和53.1%.年龄、侵犯食管和术后肿瘤残留情况是影响侵袭性分化型甲状腺癌患者预后的独立因素. 结论侵袭性分化型甲状腺癌的治疗应该以手术为主,彻底清除肿瘤是影响预后的关键因素;该类肿瘤预后较差,年龄、侵犯食管和术后肿瘤残留是影响预后的独立因素.     

多学科诊疗模式在局部晚期分化型甲状腺癌中的应用

<正>甲状腺癌(thyroid cancer,TC)是最常见的内分泌恶性肿瘤,是近年来发病率增长最快的实体肿瘤[1],在甲状腺癌中约90.0%为分化型甲状腺癌,预后较好。局部晚期分化型甲状腺癌是指颈部原发肿瘤和转移淋巴结局部侵犯周围组织,由于甲状腺的解剖学位置导致局部晚期甲状腺癌易侵犯喉、气管、喉返神经、咽和食管,引起声音改变、呼吸道阻塞、出血及吞咽困难等严重并发症。局部晚期分化型甲状腺癌约占甲状     

76例分化型甲状腺癌的诊断及治疗

目的探讨分化型甲状腺癌的临床特点、诊治。方法回顾分析2000年9月至2008年10月行手术治疗的76例甲状腺癌病例。结果甲状腺乳头状癌65例,滤泡状癌11例,均行手术治疗,所有患者术后均予甲状腺素治疗。术后发生喉返神经损伤及其他并发症4例（5．26％）,平均随访2．5年（1—5年）,颈部淋巴结转移5例。结论分化型甲状腺癌应根据病理组织类型、肿瘤大小、年龄和颈部淋巴结转移选择不同手术方式,术后辅以内分泌治疗。     

Undifferentiated thyroid cancer: improved therapeutic results following initial radical intervention and early postoperative radiotherapy

During a 16-year period (1972-1988), 40 out of 477 thyroid cancer patients underwent thyroidectomy for undifferentiated thyroid carcinoma. To analyse the significance of "radical" versus "palliative" surgical procedures with regard to early postoperative course, operative complications and survival, all patients records were reviewed and actually followed up. A significant better survival was correlated with radical (n = 17) versus palliative tumor resection (n = 23) (p less than 0.001), and total thyroidectomy (n = 22) versus subtotal thyroidectomy (n = 18) (p less than 0.006). Radical surgery with early postoperative external irradiation revealed no postoperative mortality and only one symptomatic cervical tumor recurrence. In contrast, palliative surgery, particularly in the case of synchronous tracheotomy, was attended with a relatively high mortality (30%) and symptomatic local recurrences. The results of this study suggest that in undifferentiated thyroid carcinoma without infiltration of the esophageal or tracheal mucosa an attempt of radical tumor resection should be undertaken, since palliative surgical procedures revealed a significantly lower survival due to complications of persistent or recurrent cervical tumor infiltration and frequently were accompanied by local complications during the postoperative course.     

Oncogenic emergency and treatment in thyroid disease

The urgent treatment of thyroid disease is mainly considered to be that of thyroid neoplasia, especially malignant thyroid tumors. The clinical symptoms produced by malignant neoplasia are acute respiratory failure caused by tumor compression and/or invasion of the trachea. Massive bleeding caused by tumor invasion of the major vessels also requires emergency therapy. In general, thyroid cancer has a favorable prognosis in patients with well-differentiated papillary carcinoma, which makes up more than 90% of thyroid malignancies. However, anaplastic carcinoma, undifferentiated papillary carcinoma, and malignant lymphoma originating from the thyroid sometimes require urgent therapy to save lives. Anaplastic carcinoma that is basically transformed from well-differentiated papillary carcinoma shows rapid growth and invades the surrounding tissue to produce tracheal obstruction. Repeated postoperative recurrences in patient with papillary carcinoma suggest undifferentiated carcinoma that eventually becomes the same endostage as anaplastic carcinoma. Radical surgery is needed in such cases initially, although making a differential diagnosis between well- and undifferentiated carcinoma is extremely difficult. Urgent treatment of these diseases consists of ensuring that the airway remains open to improve quality of life, but does not include radical treatment. Stent insertion is one adequate method for the urgent treatment of respiratory disturbance caused by tumor compression. Malignant lymphoma frequently develops from Hashimoto's thyroiditis. Immediately after making an accurate pathologic diagnosis, chemotherapy and/or radiation therapy are effective in reducing enlarged goiters rather than surgical management.     

Surgical treatment of invasion of the upper aerodigestive tract by well-differentiated thyroid carcinoma

Forty-eight patients with well-differentiated thyroid carcinoma invading upper aerodigestive tract structures have been described. Age at diagnosis was found to be a negative prognostic factor, and duration of disease before invasion was found to be a positive prognostic factor. Treatment with radical surgery and adjuvant therapy provided no improvement in survival over treatment with near-total (skeletonizing) excisions combined with adjuvant therapy. All patients treated with partial debulking procedures, with or without tracheotomy, died from disease. We believe that partial resection of upper aerodigestive tract structures without sacrifice of voice, normal breathing, or swallowing should be considered in patients with well-differentiated thyroid carcinoma.     

进展期腹、盆腔脏器肿瘤侵犯膀胱21例诊治分析

目的探讨进展期腹、盆腔脏器肿瘤侵犯膀胱的临床特点及其诊断和处理。方法回顾性分析经临床和病理证实的21例进展期腹、盆腔脏器肿瘤侵犯膀胱的临床资料。结果本组原发癌占13例和复发癌8例。其中降、乙状结肠癌10例,直肠癌7例,卵巢癌2例,恶性子宫内膜异位症2例。临床表现主要为便血,血尿,腹痛,腹部肿块,肾积水。手术配合化疗15例(根治性手术9例,姑息性手术6例),放弃治疗6例。术后随访15例,随访3个月～5年,平均2.6年,无瘤生存6例,局部复发带瘤生存4例,死于癌症或晚期并发症11例。结论进展期腹、盆腔脏器肿瘤侵犯膀胱,主要依据临床表现、影像和窥镜等检查而诊断。处理取决于原发肿瘤的进展情况,对局部进展侵犯膀胱者,可以施行肿瘤扩大根治手术或姑息切除术,配合化疗等综合措施,近期效果良好,生活质量改善。     

Resectional treatment for thyroid cancer with tracheal invasion: a long-term follow-up study

HYPOTHESIS: Transmural invasion of the trachea by well-differentiated thyroid carcinomas is a locally advanced disease condition. It frequently causes deaths owing to airway obstruction. We hypothesized that resection of the invaded trachea followed by primary anastomosis provides the opportunity for cure. DESIGN: A retrospective review study of medical records. SETTING: The surgical department of a tertiary referral center. PATIENTS: Eight patients with well-differentiated thyroid carcinomas, complicated with tracheal invasion resulting in bleeding and airway obstruction, operated on by tracheal resection and immediate anastomosis, were included. INTERVENTIONS: All patients received total thyroidectomy and neck lymph node dissection as well as segmental tracheal resection followed by primary reconstruction. Postoperative radioactive sodium iodine I 131 treatment and suppression therapy with thyroxine were applied to all of them. MAIN OUTCOME MEASURE: Postoperative follow-up of serum levels of human thyroglobulin and abnormal radioactive iodine 131I from whole body scan. RESULTS: Seven patients are alive. Of these patients, 5 had no evidence of disease: (3 had no evidence of cancer for more than 10 years' follow-up), 2 had regional lymph node metastasis, and 1 had lung metastases. The remaining patient had anastomotic site recurrence with airway obstruction and needed tracheostomy to relieve stridor. She was lost to follow-up 39 months after undergoing the initial operation. CONCLUSIONS: Patients with mucosal invasion of the trachea by well-differentiated thyroid carcinomas should be treated by surgical resection followed by primary reconstruction when technically feasible. This facilitates postoperative care, and it is possible to achieve long-term survival with improvement of the quality of life and possible cures.     

Surgical treatment of advanced thyroid carcinoma invading the trachea

Operative methods, in relation to the completeness of resection and surgical results, and postoperative complications, in relation to operative methods, were discussed in 60 patients with advanced thyroid carcinoma in whom tumor invading the trachea was resected along with thyroid carcinoma. Laryngotracheal anastomosis was performed in 41 patients and tracheotracheal anastomosis in 19 patients. Complete resection was performed in 22 patients in the former group and in 12 patients in the latter group. Three-, 5-, and 10-year survival rates in patients undergoing complete resection were 87.0%, 78.1%, and 78.1%, respectively. Those for patients undergoing incomplete resection were 64.9%, 43.7%, and 24.3%, respectively. The locations of remaining tumor were the tracheal stump in patients in whom resection was incomplete. In four patients with esophageal invasion, the muscular layer of the esophagus was resected. Three of these patients had good postoperative results. Postoperative complications consisted of stenosis at the anastomosis in two patients, temporary mis-swallowing in three patients, temporary lower pharyngeal stenosis in one patient, temporary vocal cord edema in one patient, and tetany in two patients.     

Squamous cell carcinoma of the thyroid gland

We present the clinical manifestations and details of treatment and outcome for eight patients with squamous cell cancer arising in the thyroid gland, which is a rare entity. All patients had advanced disease, with primary tumors invading adjacent structures (the trachea, esophagus, and major vessels). In two patients, pulmonary metastases were also present. Six patients died 6 months or less after diagnosis, five from the effects of local disease. Transient palliation was obtained in four patients who underwent partial excision (three patients) and radical radiotherapy (one patient). Two patients remained free of disease at last follow-up more than 4 years after gross total tumor resection and radical radiotherapy and were presumably cured. One patient treated by partial resection and radical radiotherapy died from other causes 17 months later. His disease status was unknown. Complete excision with postoperative radiotherapy may be curative, and debulking followed by external irradiation may provide short-term palliation. Patients with unresectable tumors are best managed by supportive measures only unless a truly effective chemotherapeutic regimen is developed for squamous cell cancer of the head and neck.     

低分化甲状腺癌治疗策略探讨

目的:对低分化甲状腺癌（poorly differentiated thyroid carcinoma,PDTC）的治疗策略进行探讨。方法:回顾性分析电子科技大学医学院附属肿瘤医院头颈外科中心2010年3月至2019年11月收治的31例PDTC患者,比较不同治疗方式对PDTC生存时间的影响,所有患者均接受手术治疗,术后...