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1.
目的 寻找侵入气管及喉的分化型甲状腺癌手术治疗的方法,探讨包括气管及喉部分切除在内的根治性手术可行性和有效性。 方法 3例均为女性,2例为甲状腺乳头状癌,1例滤泡状癌,均侵入气管。一例采取右侧甲状腺腺叶切除术、气管袖状切除术及声门下喉部分切除术,术后因喉切缘肿瘤残留补充放疗总量55 Gy;另一例采取左侧甲状腺腺叶切除术、气管袖状切除术及左改良根治性颈淋巴结清扫术;第三例采取全甲状腺切除、气管袖状和喉部分切除术、双侧改良根治性颈淋巴结清扫术和上纵隔淋巴结清扫术。 结果术后均无声音嘶哑,呼吸平稳,无需气管切开,均无吻合口漏。随访近2年均未见吻合口狭窄和肿瘤复发。 结论对侵入气管及喉的分化型甲状腺癌患者进行包括气管袖状切除术在内的根治性手术治疗是可行和有效的。  相似文献   

2.
Thyroid carcinoma invading the upper aerodigestive system   总被引:9,自引:0,他引:9  
Well-differentiated thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs it is the source of significant morbidity and excess mortality. The most common structures invaded by thyroid carcinoma are the recurrent laryngeal nerves, larynx, pharynx, and esophagus, which can produce symptoms of airway insufficiency, dysphagia, and hemoptysis. Locally invasive thyroid carcinoma can often be successfully treated while preserving function of the upper airway. If the tumor involves only the wall of the larynx or trachea without intraluminal extension, "shaving" the tumor from the trachea or larynx will produce local control rates comparable to more radical and destructive procedures. Intraluminal extension is a more serious problem that usually requires resection of a portion of the aerodigestive tract. Even in this situation, partial laryngeal or tracheal resection with preservation of function might be possible and should be used. Adjuvant therapy using radioiodine or external beam radiotherapy should be considered an integral part of any treatment plan for these tumors. These modalities will significantly reduce the rate of local recurrence and control symptomatic local disease.  相似文献   

3.
分化型甲状腺癌侵犯喉气管临床分析   总被引:1,自引:0,他引:1  
目的 探讨甲状腺癌累及喉、气管时的外科处理方法。方法 2000年1月~2010年12月在我院手术治疗晚期分化型甲状腺癌24例,根据肿瘤侵犯喉、颈段气管的范围及程度分别行肿瘤削除术和气管袖状切除端端吻合术;喉部分切除胸锁乳突肌或颈阔肌皮瓣修复术。结果 24例患者均接受根治性手术切除,喉、气管缺损修复重建。术式:肿瘤削除术8例,气管袖状切除8例,喉部分切除术8例。吻合方式:气管端端吻合8例,胸锁乳突肌皮瓣修复4例,颈阔肌皮瓣修复4例。本组患者肿瘤复发率为8.3%,5年累积生存率为91.6%。结论 对侵犯喉、气管的分化型甲状腺癌患者应采取更为积极的外科治疗,以减少术后复发,提高生存率。  相似文献   

4.
Carcinomas of the thyroid gland invading larynx and trachea   总被引:1,自引:0,他引:1  
Twenty-nine patients with a thyroid carcinoma invading the larynx and trachea were treated over a 25-yr period. Eight patients had invasion of the walls of the trachea or larynx and 21 had invasion into the lumen. Of the 15 patients who underwent limited surgery, i.e. total thyroidectomy, tracheostomy and neck dissection, 8 had intraluminal invasion and 7 suffered from bleeding into the trachea or airway obstruction. In contrast, none of the 13 who underwent extensive surgery, i.e. thyroidectomy, laryngectomy, partial resection of the trachea and one resection of the pharynx, (12 of whom had intraluminal invasion) showed either bleeding into the trachea or airway obstruction. Although the prognosis was no better in the group undergoing extensive operation there is the feeling that in cases with intraluminal invasion extensive surgery is indicated to prevent the severe airway difficulties which often develop in such patients.  相似文献   

5.
目的 探讨累及喉、气管的甲状腺乳头状癌的临床治疗经验。 方法 回顾性分析2010年1月至2019年12月山东大学齐鲁医院耳鼻咽喉科收治的87例累及喉、气管的甲状腺乳头状癌患者的基本资料,统计分析其采用的肿瘤切除方式、气管修补方法、术后拔管率及3年和5年生存率。 结果 87例患者均进行了手术治疗,肿瘤切除方式包括:气管壁肿瘤锐性剃除(60例),气管壁楔形切除(15例),气管袖状切除(3例),喉部分切除(1例),全喉切除(4例),姑息切除(4例)。气道重建方法包括:拉拢缝合(5例),胸大肌肌皮瓣修补(1例),胸锁乳突肌锁骨骨膜瓣修补(1例),端端吻合(3例),喉成型术(1例),气管造瘘术(12例)。随访时间为4-122个月,随访到79例,其中15例行气管切开,气管切开术后拔管率66.7%(10/15),3年生存率为100%,5年生存率为93.0%。 结论 对于累及喉、气管的甲状腺乳头状癌,通过准确的术前评估和合理的手术治疗,可以显著改善患者生活质量,获得良好的生存期。  相似文献   

6.
Although thyroid surgery is generally standardized, a variety of difficult problems are noted in thyroid surgery including substernal goiter, locally aggressive thyroid cancer invading surrounding tissues, and recurrent thyroid tumors. Patients with large substernal goiter with tracheal deviation or compression are generally advised to undergo surgical intervention to avoid future airway problems. The majority of the substernal goiters can be easily resected through the neck while approximately 1% to 2% will require a sternal split. The most important prognostic factor in thyroid cancer is extrathyroidal invasion into surrounding structures. This requires appropriate surgical intervention with removal of all gross tumor. If the tumor invades the trachea, appropriate tracheal resection may be necessary, which requires a complete evaluation of the larynx and trachea with imaging studies. A high incidence of local recurrence exists in patients initially presenting with extrathyroidal extension of thyroid cancer. In elderly individuals this may represent poorly differentiated thyroid cancer. Adjuvant therapy including radioactive iodine and external radiation therapy in select patients may be necessary. Management of recurrent thyroid cancer continues to be a difficult problem due to the location of the tumor, especially in the tracheoesophageal groove. Complete resection of the tumor with preservation of at least one recurrent laryngeal nerve is crucial to avoid tracheostomy. The patients at high-risk for local recurrence require close follow-up with appropriate imaging studies such as computed tomography scan and/or ultrasound with fine-needle aspiration biopsy. Difficult thyroid continues to be a surgical challenge that requires collaboration among endocrinologist, surgeon, diagnostic radiologist, and nuclear physicians.  相似文献   

7.
Laryngotracheal invasion is a rare occurrence in the thyroid carcinoma that demands aggressive complete removal of tumor to prevent mortality. The most common cause of death related to thyroid carcinoma is local invasion of the upper airway. The otolaryngologist-Head & Neck surgeon, trained in surgery of the larynx and trachea, is an expert in dealing with the most complex cases of thyroid cancer. However, successful treatment depends on a clear understanding of the regional anatomy with a goal of complete tumor removal with preservation of function. In most situations, this can be accomplished resulting in long-term local control of even the most aggressive locally invasive tumors. This study reviews a 30-year experience with treatment of locally invasive thyroid cancer. Although the principle of complete removal of tumor is unchanged regardless of the area of invasion, the guidelines for reconstruction vary greatly depending on the site and extent of the defect. Total laryngectomy is rarely necessary and even large defects of the subglottic larynx and trachea can be reconstructed. This article defines the regions of resection and those that do require reconstruction of rigid support of the airway. The study defines the concept of a “subglottic laryngectomy” with reconstruction, because the region can be affected by thyroid cancer. Large tracheal defects as well can be reconstructed. The basis of the reconstruction is the sternocleidomastoid myoperiosteal flap that provides skeletal support to the trachea on cricoid as needed. The surgical technique for reconstruction with the flap is described in detail. The use of tracheal stents for support during the healing phase is also described.  相似文献   

8.
Thirty patients with tracheal invasion of differentiated thyroid cancer underwent partial resection of the tracheal wall between 1978 and 1996 at National Cancer Center Hospital. In most cases, the defect in the tracheal wall was reconstructed secondarily using a local flap. This method was easy in comparison with end-to-end anastomosis of the trachea following circumferential resection of the wall. Partial resection of the tracheal wall proved to be a effective treatment for thyroid cancer invasion of the tracheal, because of low incidence of local recurrence. When the defect of the tracheal wall was too large to be reconstructed using a local flap, hydroxylapatite was employed and good results were obtained.  相似文献   

9.
《Auris, nasus, larynx》2023,50(1):23-31
Approximately 20% of patients with differentiated thyroid cancer (DTC) have direct tumor extension with invasion of the surrounding tissues such as the larynx, trachea, esophagus, or recurrent laryngeal nerve. Recent progress of molecular-targeted therapy, such as the use of tyrosine kinase inhibitors, improves survival outcome in patients with advanced DTC. However, induction of tyrosine kinase inhibitors for locally-advanced DTC has presented novel fatal adverse events including fistula in patients with infiltration toward to the trachea, pharynx and esophagus, and fatal bleeding in patients with great vessel invasion. Surgery therefore still has an important role in DTC management, particularly in local control. The surgical strategy for laryngeal/tracheal invasion, which commonly occurs by DTC, is decided according to the extension (depths and area) of the tumor. The “shave procedure” is performed when the tumor has superficially invaded the larynx/trachea. However, intra-luminal extension requires resection and reconstruction of the larynx/trachea wall. Large veins, such as the internal jugular vein and the subclavian vein, are also frequently directly invaded by DTC. Three types of jugular vein reconstruction have been advocated to avoid fatal complications according to bilateral jugular vein ligation. The majority of carotid artery invasion by DTC can be managed with tumor resection of the sub-adventitial layer without reconstruction surgery using an artificial vessel. In this review article, we examine surgery for advanced DTC, showing the surgical strategy toward DTC that has invaded the laryngotracheal, recurrent laryngeal nerve, esophagus/hypopharynx, or great vessels.  相似文献   

10.
累及喉气管的晚期甲状腺癌一期手术整复   总被引:4,自引:0,他引:4  
目的:探讨晚期甲状腺癌累及喉、气管时的一期手术整复方法。方法:对18例存在喉气管受累的晚期甲状腺癌患者进行一期肿瘤全切及喉气管整复,其中7例喉受累患者全喉切除3例,喉部分切除4例;18例颈段气管受累患者中,8例直接切除肿瘤,10例切除受累气管壁后,修复方法包括:拉扰缝合1例,端端吻合3例、带蒂胸锁乳突肌骨膜瓣2例、岛状胸大肌肌皮瓣3例和颈部皮瓣1例。结果:住院期间肿瘤复发死亡1例。除3例全喉切除患者外,14例成功保留喉功能,其中拔除气管套管8例,堵管2例,继续带管4例。结论:对于累及喉气管的晚期甲状腺癌采用一期手术切除并整复不仅切实可行,而且可以提高此类患者的治愈机会,改善生活质量。  相似文献   

11.
OBJECTIVE: Composite nasal septal cartilage grafts (CNSCG) are effective grafting materials in laryngeal and tracheal reconstruction following tumor resection. METHODS: Between 1985 and 2005, we used CNSCG for the reconstruction of defects following resection of laryngeal tumors with subglottic extension (20 cases), subglottic mesenchymal tumors (2 cases), invasive thyroid carcinoma (4 cases), tracheal tumors (3 cases) and esophagus carcinoma with tracheal invasion (1 case) in total of 30 patients. RESULTS: The patients with subglottic tumors were decanulated within 5-7 days except one case. We achieved satisfactory voice and swallowing without any sign of recurrence. Overall complications consisted of subglottic stenosis in one case, and unilateral paralysis of recurrent laryngeal nerve in two cases. One patient with subglottic laryngeal carcinoma died due to neck and distant metastases 4 years after the operation. All patients are well with a mean follow-up period 9 years. Three patients with tracheal tumors underwent lateral resection and reconstructed with CNSCG. Satisfactory healing of the grafts was seen in all cases without local recurrence or complication with a mean follow-up period of 62 months. One of the patients had distant metastases 3 years after the operation. The patient with esophagus carcinoma and tracheal invasion was treated by total esophagectomy, gastric pull-up, tracheal resection and CNSCG reconstruction. He died at postoperative 5th day due to mediastinitis as a complication of gastric pull-up. CONCLUSION: Free composite cartilage graft is a reliable material in the reconstruction of defects after surgery of laryngeal tumors with subglottic extension, invasive thyroid and esophagus tumors and well-selected tracheal tumors.  相似文献   

12.
To report our experience with tracheal invasive thyroid carcinoma with emphasis on clinical characteristics and treatment modalities, and to identify the prognostic factors for tracheal invasive thyroid carcinoma. Totally 1919 patients underwent surgical extirpation of thyroid cancer from 1990 to 2010. Among them, 65 patients had well-differentiated thyroid cancer with tracheal invasion. The incidence was higher in male and older patients. Patients were treated with tracheal shave excision (n = 18), tracheal resection (n = 37) and total laryngectomy (n = 10). Locoregional recurrence occurred in 39 patients, and metastasis occurred in 25 patients. Simultaneous involvement of the trachea and the esophagus was associated with locoregional recurrence (p = 0.039) in univariate analysis, but not confirmed by multivariate analysis. There was significant difference in the disease-specific survival (DSS) according to laryngeal involvement (p = 0.002). All the patient in the shave excision group survived until the end of the study period. Although it is categorized in same classification of T4a, simultaneous involvement of the trachea and the esophagus showed higher locoregional recurrence and laryngeal involvement showed lower DSS. Despite the invasion of thyroid cancer into the adjacent aerodigestive tract, many patients showed long survival when they underwent appropriate surgery.  相似文献   

13.
To explore clinical manifestation and therapies of primary malignant tumors of the cervical trachea, we retrospectively reviewed 31 patients with primary cervical tracheal malignant tumors diagnosed in the last 15 years by means of clinical manifestation, fiberoptic endoscopy, CT scanning and histopathological examinations. All of them were hospitalized and treated at the Second Xiangya Hospital, Central South University. Of them, 4 underwent emergent tracheotomy under local anesthesia, 9 were inserted with a laryngeal mask airway, 18 underwent tumorectomy under general anesthesia with endotracheal intubation, and of them 11 had tracheotomy during surgery. Of those 31 patients, tracheal malignant tumors in 9 cases were resected via laryngeal and retrograde tracheal incisions under endoscope; the tumors in 13 cases were excised via sleeve trachea resection and end-to-end anastomosis; those in 8 were removed by tracheofissure, and the tumor in 1 case was not excised surgically. Among the 30 resected patients, 20 patients received both radiotherapy and chemotherapy; 6 received radiotherapy only, and 4 did not receive any adjuvant therapies. During follow-up between 2 and 11 years, among 31 patients, there was no recurrence in 24 cases. Among the 7 deceased patients, 1 displayed multiple tracheal chondrosarcoma, 4 displayed adenoid cystic carcinoma, and 2 displayed squamous cell carcinoma. Emergency lower tracheotomy is necessary only when patients with tracheal, malignant tumors are in a critical condition. Sleeve trachea resection is the optimal therapy for tracheal malignant tumors. However, in the treatment of tracheal malignant tumors adjacent to the larynx or the involved trachea is over 6 cm in length, other surgeries shall be performed. Postoperative adjuvant radiotherapy and chemotherapy can achieve the same therapeutic effect as sleeve trachea resection.  相似文献   

14.
OBJECTIVES: The objective of the present study was to demonstrate the efficacy of the clinical application of in situ tissue engineering using a scaffolding technique for laryngeal and tracheal tissue. METHODS: We have developed a tissue scaffold made from a Marlex mesh tube covered by collagen sponge. Based on successful animal experimental studies, in situ tissue engineering with a scaffold implant was applied to repair the larynx and trachea in 4 patients. RESULTS: In 1 patient with subglottic stenosis, the thyroid cartilage, cricoid cartilage, and cervical trachea with scarring and granulation were resected and reconstructed by use of the scaffold. In 3 patients with thyroid cancer, the trachea and cricoid cartilage with tumor invasion were resected and the scaffold was implanted into the defect. Postoperative endoscopy during the observation period of 8 to 34 months showed a well-epithelialized airway lumen without any obstruction. CONCLUSIONS: Our current technique of in situ tissue engineering using a scaffold shows great potential for use in the regeneration of airway defects.  相似文献   

15.

Objectives/Hypothesis:

Tracheal autotransplants can repair extensive hemilaryngectomy defects. This technique was introduced into the clinic some 10 years ago as a means of avoiding the mutilation of a total laryngectomy in selected patients with laryngeal cancer. Our goal was to give the morphometric guidelines that guarantee an optimal functional outcome.

Study Design:

Retrospective case study.

Methods:

We morphometrically evaluated the structure and function of the larynx after autotransplantation. The close anatomic relationship between the larynx and the trachea made it possible to perform a morphometric analysis of the defect and the repair tissue before and after transplantation. Computed tomography images were used to measure the laryngeal and tracheal airway lumen and the length and width of the tracheal autotransplant. A 4‐cm long cartilaginous tracheal transplant was available for reconstruction.

Results:

Laryngeal repair was achieved with optimal restoration of the airway lumen at all laryngeal levels. We used the maximal amount of trachea that might reasonably be available for autotransplantation. This optimal morphologic repair led to the restoration of speech, swallowing, and respiratory functions.

Conclusions:

This study highlights a standardized approach for repairing a hemilaryngeal defect and selecting the appropriate amount of repair tissue. A unique characteristic of vascularized cartilaginous trachea is that it restores the airway lumen after extensive hemilaryngectomy. Tracheal autotransplantation should be included in the armamentarium of reconstructive laryngeal procedures.  相似文献   

16.
颈段气管肿瘤的诊治经验   总被引:5,自引:0,他引:5  
目的 总结原发性颈段气管肿瘤的诊治经验,提高治疗效果。方法 回顾性分析1981年1月—2002年12月在中国医学科学院肿瘤医院头颈外科治疗的38例原发性颈段气管肿瘤患者的临床资料。手术治疗26例,单纯放疗12例。气管袖状切除11例;气管壁部分切除13例,其中Ⅰ期气管修复6例;全喉、部分气管和甲状腺腺叶切除2例。结果 恶性肿瘤34例,其中腺样囊性癌19例,鳞状细胞癌10例,非霍奇金淋巴瘤2例,低分化癌1例,中分化腺癌1例,小细胞未分化癌1例。颈段气管腺样囊性癌患者3年和5年生存率分别为79.80%和48.36%,鳞状细胞癌分别为80.00%和20.00%。良性肿瘤患者均无瘤生存。治疗后并发症的发生率为18.4%(7/38),其中气管狭窄的发生率11.5%(3/26)。结论 原发性气管肿瘤多数为恶性,其中以腺样囊性癌和鳞状细胞癌居多。手术治疗为气管肿瘤首选治疗措施,气管袖状切除为手术方式之一。  相似文献   

17.
Thyroid tissue or neoplastic derivatives therefrom in the larynx or trachea have their genesis in either ectopia or a direct invasion by carcinoma of the thyroid gland proper. The benign lesions are found preponderantly in patients from regions in which goiter is endemic, and they may represent as much as 7% of all benign tracheal tumors. Laryngotracheal invasion by thyroid carcinoma also has a frequency of approximately 7%, with all histologic types represented.  相似文献   

18.
A case of subglottic and tracheal plasma cell granuloma masquerading as tumor invasion by thyroid malignancy was successfully treated using CO2 laser. A 55-year-old woman with a history of inspiratory stridor of almost 10 months duration was admitted to our clinic, and examinations revealed a mass in the subglottic space and trachea obstructing the airway. CT scan findings was suggestive of tumor invasion from a thyroid gland malignancy, however, histopathological examination of a biopsy specimen showed it to be plasma cell granuloma. Cases of plasma cell granuloma of the larynx and trachea are reviewed and discussed.  相似文献   

19.
In recent years, we have seen increasing use of partial laryngectomies for larger lesions that were previously treated by total laryngectomy. The resultant closer margins have made postoperative radiation therapy an important adjuvant treatment to conservation laryngeal surgery. We review the University of California, Los Angeles, experience with combination partial laryngectomy and postoperative radiation therapy between 1973 and 1987 for treatment of carcinoma of the larynx. Twenty-four such patients who underwent partial laryngectomies and postoperative radiation therapy are examined. Techniques of treatment, complications, and the functional ability of the remaining larynx are discussed. The locoregional control rate at 5 years was 80%. Risk factors associated with an increased risk of recurrence were positive margins, vascular invasion, and extranodal spread. There were no major problems with postoperative wound healing or airway management during the radiation treatment. Vocal and swallowing function were well preserved in most cases. We conclude that combination partial laryngectomy and radiation therapy permits preservation of laryngeal function without serious complications, and therefore is an effective treatment for selected patients with carcinoma of the larynx.  相似文献   

20.
目的 探讨异种脱细胞真皮基质修复膜修复甲状腺癌切除术后气管缺损的可行性。方法 甲状腺癌侵犯气管患者13例经甲状腺肿瘤切除、颈部淋巴结清扫、气管部分切除术,以异种脱细胞真皮基质修复膜修复气管缺损。结果 术后随访36~53个月,11例患者气管腔无肉芽生长,管腔光滑,顺利拔管;2例拔管失败,气管内肉芽形成感染1例,气管修复处内陷1例。结论 累及气管的甲状腺癌患者,可根据肿瘤切除后气管缺损范围,选择适当病例,以异种脱细胞真皮基质修复膜修复气管缺损,保障气道通畅。  相似文献   

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