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背景与目的:目前,对侵犯气管的分化型甲状腺癌(WDTC)外科治疗意见尚不一致,各国专家各抒己见。本文着重探讨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15例WDTC侵犯气管患者的临床资料,根据分化型甲状腺癌侵犯颈段气管的范围及程度,我们将根治性手术切除后气管缺损处理方法分为1)气管端端吻合法;2)组织瓣修复法;3)喉、气管分离法。结果:15例患者均接受根治性手术切除和气管缺损修复重建或喉气管分离处理。其中气管端端吻合2例,胸锁乳突肌皮瓣修复5例,胸大肌肌皮瓣修复2例,颈阔肌皮瓣修复2例,游离前臂皮瓣并多孔钛板修复2例,喉、气管分离喉部封闭、气管造瘘2例。本组病例术后拔除气管套10例,拔管率为66.67%。拔除气管套的患者,恢复喉发音讲话及维持呼吸道通气功能。未能拔除气管套的5例中,胸锁乳突肌肌皮瓣修复1例,前臂皮瓣并多孔钛板修复1例,胸大肌肌皮瓣修复1例。喉、气管分离永久性气管造瘘2例。这5例均丧失喉发音功能,需终生佩带气管套或需作永久性气管造瘘。本组患者肿瘤复发率为33.33%,五年生存率为88.89%。结论:对侵犯气管分化型甲状腺癌患者应采取更为积极的外科治疗,切除所有肿瘤病变和受累组织器官,以减少术后复发,提高生存率。
BACKGROUND & OBJECTIVE: At present, opinions on the surgical treatment of differentiated thyroid cancer (WTTC) invading the trachea are still not consistent. Experts of various countries express their opinions. This article focuses on the surgical treatment of WDTC tracheal invasion and its clinical significance. Methods: A retrospective analysis of 15 cases of WDTC tracheal patients with clinical data, according to the differentiation of thyroid cancer and the extent of the extent of the tracheal neck violations, we will radical surgical resection of tracheal defects after treatment methods are divided into 1) tracheal anastomosis; 2) tissue flap repair method; 3) laryngeal, tracheal separation method. Results: All the 15 patients underwent radical surgical resection and tracheal defect reconstruction or laryngotracheal tube separation. There were 2 cases of tracheal anastomosis, 5 cases of sternocleidomastoid flap, 2 cases of pectoralis major myocutaneous flap, 2 cases of platysma flaps, 2 cases of free forearm flap and porous titanium plate, Throat, tracheal separation of the larynx closed, tracheostomy in 2 cases. In this group of patients after removal of the tracheal tube in 10 cases, extubation rate of 66.67%. Remove the patient from the tracheal sheath, resume laryngeal speech, and maintain respiratory ventilation. Among the 5 patients who failed to remove the tracheal sheath, 1 patient had a sternocleidomastoid myocutaneous flap, 1 patient had a forearm flap and a porous titanium plate, and 1 patient had a pectoralis major myocutaneous flap. Throat, tracheal separation of permanent tracheostomy in 2 cases. All 5 patients had loss of laryngeal function, need to wear a trachea for life or need for permanent tracheostomy. The patients with tumor recurrence rate was 33.33%, five-year survival rate was 88.89%. Conclusion: More aggressive surgical treatment should be taken for patients with tracheo-typed thyroid carcinoma, and all tumor lesions and tissues and organs should be removed to reduce postoperative recurrence and improve survival rate.