甲状腺乳头状癌浸润气管腔内的外科治疗

目的 探讨乳头状甲状腺癌浸润气管腔内的诊断和治疗。方法 回顾性分析了我院1999年1月至2006年12月收治的12例甲状腺乳头状癌气管腔内浸润患者的临床资料,其中6例行气管部分切除-胸锁乳突肌肌骨膜瓣修复术（A组）,6例行气管袖状切除．端端吻合术（B组）。结果 10例患者术前即有提示气管侵犯的症状;气管镜于声门下2～4cm见病灶,气管镜细胞学涂片的阳性率为33％,CT的诊断阳性率为92％。切除的甲状腺病灶平均最大直径为3、8cm（3～7cm）;平均切除气管环数4个,A组最多7个环,B组最多4个环。围手术期并发症发生率为58％,无围手术期死亡。平均随访时间49个月,死亡2例,带瘤生存2例,A组拔管率100％。结论 综合应用各种术前检查可以为手术方案的设计提供依据,气管部分切除．胸锁乳突肌肌骨膜瓣修复术、气管袖状切除．端端吻合术是一种安全、有效的修复气管切除术所致气管缺损的方法。

Surgical management of papillary thyroid carcinoma with endotracheal infiltration

OBJECTIVE: To investigate the diagnosis and treatment of papillary thyroid carcinoma with endotracheal infiltration. METHODS: Clinical data of 12 patients treated from January 1999 to December 2006 were retrospectively analyzed. Six patients received tracheal partial resection-sternocleidomastoid musculoperiosteal flap reconstruction (group A). Six patients received tracheal sleeve resection-end to end anastomosis (group B). RESULTS: Ten patients had the symptoms which indicated the tracheal invasion. Endotracheal focuses were detected in the region from 2 cm to 4 cm under glottis by endoscopy and positive rate of smear biopsy was 33%. Positive rate of CT scan was 92%. Mean diameter of carcinoma focus was 3.8 cm (from 3 cm to 7 cm), and mean number of tracheal ring resected was 4. For group A, even 7 rings were resected, and the longest longitude and latitude was 7 cm and 3 cm, respectively. For group B, the greatest number of rings resected was 4. Incidence rate of perioperative complication and mortality was 58% and 0%, respectively. Mean duration of follow-up was 49 months. One patient died of local recurrence, 1 patient died of lung metastasis. Two patients with tumor recurrence were also alive. For group A, extubation was successful in all patients. CONCLUSIONS: Comprehensive use of diagnostic methods, especially MRI, will give detailed information for operation. Tracheal partial resection-sternocleidomastoid musculoperiosteal flap reconstruction and tracheal sleeve resection-end to end anastomosis are safe and useful methods to reconstruct the defects caused by tracheal operation.