山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (3): 46-51.doi: 10.6040/j.issn.1673-3770.1.2020.033

• 临床研究 • 上一篇    下一篇

累及喉、气管的甲状腺乳头状癌临床治疗分析

夏同良,魏东敏,钱晔,李文明,季炜,潘新良,雷大鹏   

  1. 国家卫生健康委员会 山东大学齐鲁医院 耳鼻喉科学重点实验室/山东大学齐鲁医院 耳鼻咽喉科, 山东 济南 250012
  • 发布日期:2020-06-29
  • 通讯作者: 雷大鹏. E-mail:leidapeng@sdu.edu.cn
  • 基金资助:
    山东省重点研发计划项目(2019GSF108003,2019GSF108097)

Clinical analysis of malignant thyroid tumors with laryngotracheal invasion

XIA Tongliang, WEI Dongmin, QIAN Ye, LI Wenming, JI Wei, PAN Xinliang, LEI Dapeng   

  1. Department of Otorhinolaryngology, State Key Laboratory of Otolaryngology (Shandong University)/ Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Published:2020-06-29

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
[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.
[1] 李静静,武欣欣,毛宁,郑桂彬,牟亚魁,初同朋,贾传亮,郑海涛,米佳,宋西成. 基于CT影像组学诺模图术前预测甲状腺乳头状癌颈部中央区淋巴结转移的研究[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 51-59.
[2] 薛刚,孙新民,林旭,吴靖芳. KCNK5双孔钾通道蛋白在甲状腺乳头状癌中的表达及临床意义[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 64-69.
[3] 黄方,周小平. 口腔颌面颈部多间隙感染63例[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 104-107.
[4] 郑桂彬, 张国军, 马驰, 韦树建, 孙海清, 吴国长, 郭雅文, 郑海涛, 宋西成. 经口腔前庭入路腔镜甲状腺手术在甲状腺乳头状癌中的安全效用分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 58-63.
[5] 黄乃思, 马奔, 官青, 王蕴珺, 魏文俊, 卢忠武, 杨舒雯, 徐伟博, 向俊, 嵇庆海, 王宇. 侧颈部淋巴结示踪技术在甲状腺癌手术治疗中的应用[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 69-74.
[6] 宁玉东, 蔡永聪, 孙荣昊, 姜健, 周雨秋, 税春燕, 汪旭, 郑王虎, 何天琪, 李超. 甲状腺乳头状癌前上纵隔淋巴结转移临床病理特征初步分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 120-124.
[7] 刘怀涛,马瑞霞,程雷. 难治性变应性鼻炎的外科治疗[J]. 山东大学耳鼻喉眼学报, 2017, 31(3): 18-21.
[8] 臧健,刘茜,姜学钧. 聚焦超声配合鼻喷激素治疗变应性鼻炎的疗效观察[J]. 山东大学耳鼻喉眼学报, 2016, 30(4): 56-59.
[9] 黄晓明,梁发雅,余诗桐. 内镜下甲状腺乳头状腺癌的手术[J]. 山东大学耳鼻喉眼学报, 2016, 30(2): 13-16.
[10] 周鹏,贺青卿,庄大勇,范子义,郑鲁明,朱见,于芳,岳涛,董学峰. 甲状腺乳头状癌颈部淋巴结转移规律的临床分析[J]. 山东大学耳鼻喉眼学报, 2013, 27(6): 12-15.
[11] 韩浩伦,吴玮,王鸿南,李保卫,丁瑞英. 老年人顽固性鼻出血的临床特点及治疗方法[J]. 山东大学耳鼻喉眼学报, 2012, 26(6): 48-49.
[12] 王欣如1,2,刘志艳3,李丽珍1,黄涛2,夏斌4,李芳邻1,2. TGF-β1G-800A、C-509T单核苷酸基因多态性与甲状腺乳头状癌易感性的关系[J]. 山东大学耳鼻喉眼学报, 2012, 26(3): 28-32.
[13] 洪育明1,甘卫刚2,梁振源1,吴文源1. 腮腺多形性腺瘤187例临床分析[J]. 山东大学耳鼻喉眼学报, 2011, 25(1): 14-16.
[14] 陆忠华, 潘新良
. 喉复发癌外科治疗进展[J]. 山东大学耳鼻喉眼学报, 2009, 23(1): 28-31 .
[15] 潘新良,雷大鹏,许风雷,张立强,栾信庸 . 下咽癌的外科治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 1-07 .
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张晗,黄一飞 . 抗角膜移植排斥的研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 84 -87 .
[2] 牛善利,柴茂文,李振秀 . 鼻内镜下鼻甲成形术治疗慢性肥厚性鼻炎60例[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 16 -18 .
[3] 孟庆国,卢永田,范献良 . 杀伤细胞免疫球蛋白样受体基因多态性与鼻咽癌的关联性[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 196 -199 .
[4] 马玉起,孔祥春 . 先天性双侧下唇窦道1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 199 -199 .
[5] 万俐佳,鲁海涛,姜义道,刘 辉,李 琴,佘腊枝 . 改良腭咽成形术治疗阻塞性睡眠呼吸暂停综合征41例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 204 -205 .
[6] 于青青 ,王跃建 . 硬质耳内镜的临床应用进展[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 222 -224 .
[7] 吉晓滨,邓家德,臧林泉,王 磊,谢 军 . 豚鼠变应性鼻炎模型血清组胺的测定[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 228 -230 .
[8] 向登,卢永田,孙焕吉 . 鼻内镜下修补脑脊液鼻漏19例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 234 -236 .
[9] 邱恩惠,李志春,方文旭 . 嗅觉障碍的中西医治疗[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 253 -257 .
[10] 殷国华,钟 笑 . 激光减容术治疗舌扁桃体肥大的远期疗效[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 280 -282 .