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目的探讨乳头状甲状腺癌浸润气管腔内的诊断和治疗。方法回顾性分析了我院1999年1月至2006年12月收治的12例甲状腺乳头状癌气管腔内浸润患者的临床资料,其中6例行气管部分切除-胸锁乳突肌肌骨膜瓣修复术(A 组),6例行气管袖状切除-端端吻合术(B 组)。结果10例患者术前即有提示气管侵犯的症状;气管镜于声门下2～4 cm 见病灶,气管镜细胞学涂片的阳性率为33%,CT 的诊断阳性率为92%。切除的甲状腺病灶平均最大直径为3.8 cm(3～7 cm);平均切除气管环数4个,A 组最多7个环,B 组最多4个环。围手术期并发症发生率为58%,无围手术期死亡。平均随访时间49个月,死亡2例,带瘤生存2例,A 组拔管率100%。结论综合应用各种术前检查可以为手术方案的设计提供依据,气管部分切除-胸锁乳突肌肌骨膜瓣修复术、气管袖状切除-端端吻合术是一种安全、有效的修复气管切除术所致气管缺损的方法。
Objective To investigate the diagnosis and treatment of papillary thyroid carcinoma infiltrating tracheal cavity. Methods The clinical data of 12 patients with invasive thyroid papillary carcinoma treated by endotracheal intubation in our hospital from January 1999 to December 2006 were retrospectively analyzed. Six patients underwent tracheal partial resection - sternocleidomastoid flap repair Surgery (group A), 6 cases of tracheal sleeve resection - end anastomosis (group B). Results 10 patients showed symptoms of tracheal invasion before operation. Tracheoscope showed lesions at 2 ~ 4 cm under the supraglottic duct. The positive rate of tracheoscope cytology smears was 33%, and the positive rate of CT diagnosis was 92%. The average diameter of the excised thyroid lesions was 3.8 cm (3 to 7 cm). The number of resected tracheal rings was 4 on average, 7 in group A and 4 in group B, respectively. Perioperative complications occurred in 58% of patients without perioperative deaths. The average follow-up time was 49 months, with 2 deaths and 2 tumor-bearing tumors. The rate of extubation in group A was 100%. Conclusion The comprehensive application of various preoperative examinations can provide the basis for the design of surgical plans. Partial tracheal resection - sternocleidomastoid flap repair and tracheal sleeve resection - end anastomosis is a safe and effective method to repair the trachea Method of tracheal defect caused by resection.