累及喉、气管的甲状腺乳头状癌临床治疗分析

doi:10.6040/j.issn.1673-3770.1.2020.033

摘要/Abstract

摘要： 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。

关键词: 甲状腺乳头状癌, 喉气管侵犯, 外科治疗

Abstract: Objective To explore the clinical treatment outcomes in thyroid papillary carcinoma patients with laryngotracheal invasion. Methods The study involved 87 patients with papillary thyroid carcinomas involving the larynx and trachea who reported to the Department of Otolaryngology at the Qilu Hospital of Shandong University between January 2010 and December 2019. Their basic demographic data, tumor resection procedures, tracheal repair procedures, postoperative extubation rate, and 3-year and 5-year survival rates were retrospectively analyzed. Results All the 87 patients were treated surgically. Tumor resection procedures included sharp shaving of the tracheal wall tumor(60 cases), tracheal wall wedge resection(15 cases), tracheal sleeve resection(3 cases), partial laryngectomy(1 case), total laryngectomy(4 cases), and palliative resection(4 cases). Airway reconstruction procedures included, suturing(5 cases), pectoralis major muscle flap repair(1 case), sternocleidomastoid clavicle periosteum flap repair(1 case), end-to-end anastomosis(3 cases), laryngoplasty(1 case), and tracheostomy(12 cases). Seventy-nine patients were followed for 4–122 months, of which 15 patients underwent tracheotomy, with an extubation rate of 66.7%(10 out of 15 patients). The 3-year and 5-year survival rates were 100% and 93.0%, respectively. Conclusion Accurate preoperative evaluation and reasonable surgical treatment may significantly improve the quality of life and facilitate the satisfactory survival of patients with thyroid papillary carcinoma involving the larynx and trachea.

Key words: Thyroid papillary carcinoma, Laryngotracheal invasion, Surgical treatment

中图分类号:

R445

夏同良,魏东敏,钱晔,李文明,季炜,潘新良,雷大鹏. 累及喉、气管的甲状腺乳头状癌临床治疗分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 46-51.

XIA Tongliang, WEI Dongmin, QIAN Ye, LI Wenming, JI Wei, PAN Xinliang, LEI Dapeng. Clinical analysis of malignant thyroid tumors with laryngotracheal invasion[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(3): 46-51.

参考文献

[1] 徐新博, 李文明, 金童, 等. 分化型甲状腺癌累及喉气管的外科治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(24): 1934-1937. doi:10.13201/j.issn.1001-1781.2014.24.008. XU Xinbo, LI Wenming, JIN Tong, et al. Surgical treatment of differentiated thyroid carcinoma with laryngeal or tracheal invasion[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2014, 28(24): 1934-1937. doi:10.13201/j.issn.1001-1781.2014.24.008.
[2] Lim H, Devesa SS, Sosa JA, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013[J]. JAMA, 2017, 317(13): 1338-1348. doi:10.1001/jama.2017.2719.
[3] Kitahara CM, Sosa JA. The changing incidence of thyroid cancer[J]. Nat Rev Endocrinol, 2016, 12(11): 646-653. doi:10.1038/nrendo.2016.110.
[4] Wang TS, Sosa JA. Thyroid surgery for differentiated thyroid cancer - recent advances and future directions[J]. Nat Rev Endocrinol, 2018, 14(11): 670-683. doi:10.1038/s41574-018-0080-7.
[5] Tuttle RM, Haugen B, Perrier ND. Updated American joint committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer(eighth edition): what changed and why?[J]. Thyroid, 2017, 27(6): 751-756. doi:10.1089/thy.2017.0102.
[6] Naoum GE, Morkos M, Kim B, et al. Novel targeted therapies and immunotherapy for advanced thyroid cancers[J]. Mol Cancer, 2018, 17(1): 51. doi:10.1186/s12943-018-0786-0.
[7] 张凌, 朱永学, 嵇庆海. 分化型甲状腺癌侵犯喉气管的治疗进展[J]. 中华外科杂志, 2007, 45(13): 885-886.
[8] Chernichenko N, Shaha AR. Role of tracheal resection in thyroid cancer[J]. Curr Opin Oncol, 2012, 24(1): 29-34. doi:10.1097/CCO.0b013e32834d6dd7.
[9] 高晓倩, 姜震, 耿琛琛, 等. 术前超声评估分化型甲状腺癌颈部淋巴结转移[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 135-139. doi:10.6040/j.issn.1673-3770.0.2018.443. GAO Xiaoqian, JIANG Zhen, GENG Chenchen, et al. Preoperative ultrasonography in detecting cervical lymph node metastasis in differentiated thyroid cancer[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(1): 135-139. doi:10.6040/j.issn.1673-3770.0.2018.443.
[10] Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology[J]. Thyroid, 2017, 27(11): 1341-1346. doi:10.1089/thy.2017.0500.
[11] Ke J, Jianyong L, Ying L, et al. The use of The Bethesda System for Reporting Thyroid Cytopathology in a Chinese population: An analysis of 13 351 specimens[J]. Diagn Cytopathol, 2019,47(9):876-880. doi: 10.1002/dc.24207.
[12] Heikkinen M, Mäkinen K, Penttilä E, et al. Incidence, risk factors, and natural outcome of vocal fold paresis in 920 thyroid operations with routine pre- and postoperative laryngoscopic evaluation[J]. World J Surg, 2019, 43(9): 2228-2234. doi:10.1007/s00268-019-05021-y.
[13] Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2016, 26(1): 1-133. doi:10.1089/thy.2015.0020.
[14] 赵雪柠, 叶萍, 潘新良, 等. 晚期甲状腺癌累及喉、气管和食管的外科治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(3): 260-262.
[15] 房居高. 强化手术技能和规范诊疗是提高甲状腺癌疗效的根本[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 1-4. doi:10.6040/j.issn.1673-3770.1.2016.01. FANG Jugao. Operation skill and standard diagnosis and treatment are the basics of improving the curative effect of thyroid carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(2): 1-4. doi:10.6040/j.issn.1673-3770.1.2016.01.
[16] Moritani S. Surgical management of cricotracheal invasion by papillary thyroid carcinoma[J]. Ann Surg Oncol, 2015, 22(12): 4002-4007. doi:10.1245/s10434-015-4492-5.
[17] Kim H, Jung HJ, Lee SY, et al. Prognostic factors of locally invasive well-differentiated thyroid carcinoma involving the trachea[J]. Eur Arch Otorhinolaryngol,2016,273(7): 1919-1926. doi: 10.1007/s00405-015-3724-4.
[18] Czaja JM, McCaffrey TV. The surgical management of laryngotracheal invasion by well-differentiated papillary thyroid carcinoma[J]. Arch Otolaryngol Head Neck Surg, 1997, 123(5): 484-490. doi:10.1001/archotol.1997.01900050030003.
[19] Nishida T, Nakao K, Hashimoto T. Local control in differentiated thyroid carcinoma with extrathyroidal invasion[J]. Am J Surg, 2000, 179(2): 86-91. doi:10.1016/s0002-9610(00)00275-0.
[20] Ebihara M, Kishimoto S, Hayashi R, et al. Window resection of the trachea and secondary reconstruction for invasion by differentiated thyroid carcinoma[J]. Auris Nasus Larynx, 2011, 38(2): 271-275. doi: 10.1016/j.anl.2010.09.003.
[21] Gozen ED, Yener M, Erdur ZB, et al. End-to-end anastomosis in the management of laryngotracheal defects[J]. J Laryngol Otol, 2017, 131(5): 447-454. doi:10.1017/S0022215117000378.
[22] Honings J, Stephen AE, Marres HAM, et al. The management of thyroid carcinoma invading the larynx or Trachea[J]. Laryngoscope, 2010, 120(4): 682-689. doi:10.1002/lary.20800.
[23] Peng AQ, Li YZ, Yang XM, et al. A review of the management and prognosis of thyroid carcinoma with tracheal invasion[J]. Eur Arch Otorhinolaryngol, 2015, 272(8): 1833-1843. doi:10.1007/s00405-014-3144-x.
[24] Segal K, Shpitzer T, Hazan A, et al. Invasive well-differentiated thyroid carcinoma: effect of treatment modalities on outcome[J]. Otolaryngol Head Neck Surg, 2006, 134(5): 819-822. doi:10.1016/j.otohns.2005.11.040.

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