目的:探讨累及颈总动脉的晚期甲状腺恶性肿瘤手术治疗的可能性。方法:回顾我院耳鼻咽喉科2006-07-2009-08期间收治的4例晚期甲状腺恶性肿瘤患者,CT示颈总动脉包裹于肿瘤中。其中低分化鳞状细胞癌2例,乳头状癌2例。3例行全甲状腺全喉切除双侧颈淋巴结清扫术,1例切除肿瘤及累及气管,保留全喉及切除气管段之气管膜部及软骨,永久性气管造瘘,颈胸部皮瓣转移修补上纵隔气管壁。术中1例颈总动脉破裂行修补术。术后2例乳头状癌及1例低分化鳞状细胞癌患者未作放、化疗,1例低分化鳞状细胞癌患者补充放、化疗。随访6个月～2年。结果:术后6个月,未放化疗的1例低分化癌患者脊柱转移,1年后仍生存,1年半后失访。其余3例随访6个月～2年未见局部明显复发或全身转移。结论:晚期甲状腺恶性肿瘤累及颈总动脉时仍可以考虑手术治疗,其中喉、气管结构应在不影响治疗效果的前提下尽量保存,缺损气管段的修复在这类病例应放在次要的地位。 Objective: To investigate the possibility of surgical treatment of advanced thyroid malignancies involving the common carotid artery. Methods: Four patients with advanced thyroid malignant tumor admitted to our department of Otorhinolaryngology 2006-07-2009-08 were retrospectively reviewed. CT showed the common carotid artery was encapsulated in the tumor. Among them, 2 cases were poorly differentiated squamous cell carcinoma and 2 cases were papillary carcinoma. 3 cases of total thyroidectomy with bilateral neck lymph node dissection, 1 case of tumor removal and tracheal involvement, the preservation of the whole throat and resection of the tracheal segment of the tracheal and cartilage, permanent tracheal fistula, neck and chest flap transfer and repair Mediastinal tracheal wall. 1 case of common carotid artery rupture repair. Two cases of papillary carcinoma and one case of poorly differentiated squamous cell carcinoma were treated with radiotherapy and chemotherapy and one case of poorly differentiated squamous cell carcinoma. Followed up for 6 months to 2 years. Results: At 6 months after operation, one patient with poorly differentiated carcinoma who had not received radiotherapy and chemotherapy had metastasis to the spine, and survived one year later, and was lost to follow-up one and a half years later. The remaining 3 cases were followed up for 6 months to 2 years, no significant local recurrence or systemic metastasis. Conclusions: Surgical treatment of advanced thyroid malignant tumors involving the common carotid artery may still be considered. The laryngeal and tracheal structures should be preserved as far as possible without affecting the therapeutic effect. The repair of the defective tracheal segment should be placed in a secondary position in such cases .