侵犯气管的分化型甲状腺癌气管袖状切除术

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。

Tracheal sleeve resection for thyroid carcinoma with tracheal invasion

Objective To evaluate approaches of aggressive surgery on differentiated thyroid carcinoma with airway invasion. Methods Three females of differentiated thyroid carcinoma with trachea invasion were selected. Two of them with papillary carcinoma and one with follicular carcinoma, ages from 38 to 45. One case underwent resection of total right lobar of thyroid, sleeve trachea and partial larynx, and 55 Gy radiotherapy was administered after operation; One case underwent left lobar thyroid and circumferential sleeve resection, with left neck modified radical dissection; The third case received total thyroid resection, trachea sleeve resection and bilateral neck modified radical dissection. Results There were no death, no tracheal stenosis and fistulae and no laryngeal recurrent nerve palsy after operation. No local recurrence was observed in trachea after 2 years follow up. Conclusion Aggressive surgical approaches including sleeve resection of trachea on differentiated thyroid carcinoma with airway invasion could be viable and effective.