【摘要】 目的探讨分化型甲状腺癌(well differentiated thyroid carcinoma,WDTC)侵犯气管的外科治疗方法及其临床意义。方法回顾性分析2001年1月至2012年10月期间收治的40例WDTC侵犯气管患者的临床资料。根据肿瘤侵犯气管的范围和程度选择不同的手术方法。A组:肿瘤锐性削除手术(25例);B组:根治性手术切除(气管窗式切除8例、全喉切除4例);C组:姑息性切除3例。术后辅助核素治疗及内分泌治疗。采用Kaplan-Meier法计算生存率。结果全组随访时间5~10年,其中2例失访。A、B、C三组患者总的5年生存率分别为92%、91.6%、33.3%,A组与B组10年总生存率分别为80%、71.4%。接受根治性手术+气管窗式切除的患者,均在术后6个月内拔除气管套管,未出现气管狭窄等明显并发症,生存质量良好,其中1例患者在术后第3年出现肺部转移,目前带瘤存活。全喉切除患者,1例在术后出现咽漏,经换药治疗后好转。A组与B组生存率比较,χ2=0.194,P=0.659,差异无统计学意义;A组与C组生存率比较,χ2=26.890,P=0.000,差异有统计学意义;B组与C组生存率比较,χ2=14.504,P=0.000,差异有统计学意义,C组的生存率明显下降。结论对侵犯气管的WDTC患者,应根据肿瘤侵犯气管范围的不同,选择相应的手术方式,但都应在尽量保留功能的前提下切除所有肿瘤病变和受累组织器官。更多还原

【Abstract】 Objective To evaluate different surgical procedures and the clinical significance of well differentiated thyroid carcinoma( WDTC) with tracheal invasion. Methods Clinical data were reviewed and analyzed in 40 patients treated for WDTC with tracheal invasion from January 2001 to October 2012. Different surgical treatments were applied according to the extent of tracheal invasion,in which group A was shave excision( 25 cases),group B was radical surgery including tracheal window resection( 8 cases) and total laryngectomy( 4 cases) and group C was incomplete tumor resection( 3 cases). These patients received radionuclide therapy and endocrine therapy after surgery. Survival rate was evaluated using the Kaplan-Meier analysis. Results The overall 5-year survival rate was 92% 、91. 6% and 33. 3% in group A,B and C respectively. The overall10-year survival rate was 80% and 71. 4% of group A and B. All the patients who received tracheal window resection got the tracheal tube removed within six months after operation without complication. One patient had lung metastasis 3 years after operation,and was currently alive with tumor. One of the total laryngectomy patients appeared pharyngeal leak and got better after dressing change. The difference of survival rate in group A and B was not statistically significant( χ2= 0. 194,P = 0. 659). But it significantly decreased in group C comparing with group A( χ2= 26. 890,P = 0. 000) and group B( χ2= 14. 504,P = 0. 000). Conclusion A more aggressive surgical treatment should be taken in well differentiated thyroid cancer patients with tracheal invasion. The appropriate surgical approach should be selected to reduce the recurrence according to the trachea range of different tumor invasion. All the tumor lesions and organs should be removed in the premise of function preservation.更多还原