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目的:总结侵犯上呼吸消化道甲状腺癌治疗的临床经验,提高其生存率和生活质量。方法:侵犯上呼吸消化道甲状腺癌患者33例中,全甲状腺切除7例,患侧腺叶切除对侧次全切除22例,甲状腺部分切除4例。气管局部切除开窗气管插管19例,部分喉、梨状窝切除气管局部切除开窗插管4例,气管袖状切除术、端端吻合10例。结果:所有患者均一期愈合,无气管吻合口瘘、气管壁坏死、食管瘘及咽瘘。1例出现甲状旁腺功能低下,术后1个月好转。死亡7例(21.21%)。侵犯上呼吸消化道甲状腺乳头状癌的1、3、5年生存率分别为100.0%、93.8%和70.3%;侵犯上呼吸消化道甲状腺癌的1、3、5年生存率分别为96.6%、79.0%和61.4%。结论:甲状腺癌侵入气管内、下咽可以手术治疗,恰当地选择术式可以提高生存率和生存质量。气管袖状切除、端端吻合是较理想的重建气管的方法。
OBJECTIVE: To summarize the clinical experience of invasive thyroid cancer in upper respiratory tract and to improve its survival rate and quality of life. Methods: Thirty-three patients with thyroid cancer invading upper respiratory tract were treated with total thyroidectomy in 7 cases, 22 cases with contralateral subtotal lobectomy and 4 cases with partial thyroidectomy. Local tracheal resection of the tracheal intubation in 19 cases, part of the throat, pear-shaped resection of the trachea resection of local tracheal intubation in 4 cases, tracheotomy, end-to-end anastomosis in 10 cases. Results: All patients were cured at one time, without tracheostomy fistula, tracheal wall necrosis, esophageal fistula and pharyngeal fistula. One case had hypoparathyroidism and improved one month after surgery. 7 cases died (21.21%). The 1, 3, 5-year survival rates of invasive papillary thyroid carcinoma in the upper respiratory tract were 100.0%, 93.8% and 70.3%, respectively. The 1, 3, 5-year survival rates of invasive thyroid cancer in upper respiratory tract were 96.6% 79.0% and 61.4%. Conclusion: Thyroid cancer invading the trachea and hypopharynx can be surgically treated. Appropriate surgical procedures can improve the survival rate and quality of life. Tracheal sleeve resection, end anastomosis is the ideal method of reconstruction of the trachea.