蔡伟华-分化型甲状腺癌侵犯喉、气管及食管的外科治疗方法探讨.doc.docVIP

分化型甲状腺癌侵犯喉、气管及食管的外科治疗方法探讨 蔡伟华#曹永晋福建医科大学附属第一医院甲状腺乳腺科 350005) 摘要：目的 探讨已侵犯喉、气管及食管的分化型甲状腺癌外科治疗方法。 方法 15例已侵犯喉、气管、食管的分化型甲状腺癌患者，2例行甲状腺叶全切除、双侧功能性颈淋巴结清扫术、全喉切除及气管造瘘术；4例行甲状腺叶切除、功能性颈淋巴结清扫术及气管部分切除、胸锁乳突肌骨膜瓣转移修复术；9例行甲状腺叶切除、功能性颈淋巴结清扫术及食管部分切除缝合修复术，并随访各患者的预后。结果 随访12～58月，1例术后18个月出现胸骨后复发，经放射治疗后存活至今，其余14例术后未出现局部复发。结论 分化型甲状腺癌如侵犯喉、气管、食管局部器官，应尽可能行甲状腺肿瘤及受侵器官联合切除，降低出血、梗阻、呼吸困难等导致的死亡率。术后配合外放射及同位素治疗，提高生存率。 关键词：癌，甲状腺；侵袭；外科治疗；预后 Approach on Surgical Treatment of Thyroid Carcinoma with Differentiated Type Invading the Laryns, Trachea and Esophageal Cai Wei-hua, Cao Yong-jin(Department of thyroid gland and mammary gland, Affiliated First Hospital of Fujian Medical University, Fujian Province Fuzhou, 350005) Abstract OBJECTIVE To explore the surgical therapy of thyroid carcinoma invading the larynx, trachea and esophageal with differentiated type. METHODS In 15 patients with thyroid carcinoma invading the larynx, trachea and esophageal, two cases underwent lobus glandulae thyroideae resection, double-functional lymphonodi cervicales sweep, whole-larynx resection and trachea fistulation; 4 cases underwent lobus glandulae thyroideae resection, double-functional lymphonodi cervicales sweep, partial trachea resection, sternocleidomastoid periosteum valve transfer prosthesis; 9 cases underwent lobus glandulae thyroideae resection, double-functional lymphonodi cervicales sweep and partial esophageal resection and suturation prosthesis. The clinical data of all the patients with thyroid carcinoma invading the larynx, trachea and esophageal with differentiated type were followed-up. RESULTS Twelve to fifty-eight months after following-up, 1 case developed recurrence in breast bone 18 months after operation, and survived after radiotherapy; 14 cases did not develop local recurrence after operation. CONCLUSION For the patients with thyroid carcinoma invading the larynx, trachea and esophageal with differentiated type, we should perform the resection of thyroid carcinoma combined with the invaded organs to r