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目的:探讨甲状腺癌累及喉、气管、食管、下咽时的外科处理。方法:对17例伴有喉、气管、食管、下咽受累的分化型甲状腺癌患者行一期肿瘤切除。17例患者均有喉气管受累,其中14例分别行肿瘤削除术、气管楔形切除缝合术、气管窗状切除胸锁乳突肌肌骨膜瓣修复术、气管袖状切除端端吻合术、气管袖状切除游离前臂皮瓣气管重建术;3例行喉全切或近全切除术。伴有食管、下咽受累者11例分别行肌层切除或食管部分切除胸大肌肌皮瓣修复术。伴有喉返神经受累者12例行喉返神经松解术、喉返神经切除一期杓状软骨内收术和(或)颈袢喉返神经修复术9例,单纯喉切除术3例。结果:17例患者术后随访1～12年,5年生存率93.3%,手术并发症发生率23.5%。行肿瘤削除术及气管部分切除术各有1例复发,其余术后均无局部复发。喉返神经松解或行相关发音重建的9例患者术后嗓音均有明显改善,其中5例恢复正常。结论:累及喉、气管、食管、下咽的分化型甲状腺癌仍可手术切除并行功能重建以提高治愈率,改善生活质量;手术方法的选择依赖于肿瘤侵犯的部位、范围、喉返神经浸润的程度与病程;手术创伤大,修复重建较复杂,并发症发生率较高。
Objective: To investigate the surgical treatment of thyroid cancer involving the larynx, trachea, esophagus and hypopharynx. Methods: Tumor resection was performed in 17 cases of differentiated thyroid carcinoma with laryngeal, tracheal, esophageal and hypopharyngeal involvement. Twenty-seven patients had laryngotracheal involvement, of which 14 patients underwent tumor resection, tracheotomy wedge resection and suture, tracheal window resection sternomastoid muscle flap repair, tracheal sleeve resection end anastomosis, tracheal sleeve Resection of the free forearm flap tracheal reconstruction; 3 cases of laryngectomy or subtotal resection. Esophageal and hypopharyngeal involvement in 11 cases were treated with myomectomy or esophageal resection of pectoralis major myocutaneous flap repair. Twelve patients with recurrent laryngeal nerve involvement underwent recurrent laryngeal nerve lysis, 9 patients with recurrent laryngeal nerve resection of arytenoid adduction and / or recurrent nephrolithotomy, and 3 simple laryngectomy. Results: Seventeen patients were followed up for 1 to 12 years. The 5-year survival rate was 93.3%. The incidence of complications was 23.5%. Tumor resection and tracheal partial resection in 1 case of recurrence, the rest were no local recurrence. Nine patients with recurrent laryngeal nerve rebuild or line related phonation had significant improvement in postoperative voice, of which 5 returned to normal. Conclusion: Thyroid, tracheal, esophageal and hypopharyngeal differentiated thyroid carcinoma can still be reconstructed by surgical resection in order to improve the cure rate and improve the quality of life. The choice of surgical method depends on the location and extent of tumor invasion, recurrent laryngeal nerve infiltration Degree and course of disease; surgical trauma, repair and reconstruction more complicated, a higher incidence of complications.