中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2011年
11期
901-904
,共4页
魏伯俊%申虹%邢小平%姬巍%赵亮%王佳%谢洪%周小红%尹金淑%姜涛%昌红%石峰
魏伯俊%申虹%邢小平%姬巍%趙亮%王佳%謝洪%週小紅%尹金淑%薑濤%昌紅%石峰
위백준%신홍%형소평%희외%조량%왕가%사홍%주소홍%윤금숙%강도%창홍%석봉
甲状旁腺肿瘤%再手术
甲狀徬腺腫瘤%再手術
갑상방선종류%재수술
Parathyroid neoplasms%Reoperation
目的 探讨侵犯上消化呼吸道复发性甲状旁腺癌的术后复发原因及再手术疗效.方法 回顾总结6例伴上消化呼吸道侵犯的甲状旁腺癌患者首次手术方法、术后复发部位、复发间隔时间,本次手术方法及其血钙和甲状旁腺激素的水平的动态改变.6例患者之前的手术次数分别为4次者2例,2次、3次、5次和7次者各1例,上次手术后血钙及PTH无改善者3例.本组患者本术前的甲状旁腺激素值为860～2830 ng/L.行Ⅱ、Ⅲ、Ⅳ及Ⅵ区淋巴结清扫3例,Ⅱ～Ⅵ区、Ⅱ～Ⅶ区和Ⅲ～Ⅶ区清扫各1例,对术后缺损器官行一期修复.5例患者行预防性气管切开.结果 病理结果显示6例患者均有上消化呼吸道侵犯,其中单纯气管食管侵犯者4例,气管、食管、喉和下咽均受侵者1例,单纯喉内侵犯1例.2例伴Ⅳ及Ⅶ区淋巴结转移.本次手术后所有甲状旁腺激素均于术后2h内恢复正常,高钙血症均于术后24h内消失.4例患者随诊11 ～40个月PTH和血钙均在正常范围,另2例分别于术后8个月和11个月再次局部复发.术后并发食管瘘和淋巴管瘘各1例,均于保守治疗后愈合.6例患者出院时均拔管.1例患者并发胸骨愈合不良.结论 局部复发并侵犯上消化呼吸道的甲状旁腺癌可获得较好的手术效果,术前准确定位和术中甲状旁腺激素监测是保证手术成功的关键.
目的 探討侵犯上消化呼吸道複髮性甲狀徬腺癌的術後複髮原因及再手術療效.方法 迴顧總結6例伴上消化呼吸道侵犯的甲狀徬腺癌患者首次手術方法、術後複髮部位、複髮間隔時間,本次手術方法及其血鈣和甲狀徬腺激素的水平的動態改變.6例患者之前的手術次數分彆為4次者2例,2次、3次、5次和7次者各1例,上次手術後血鈣及PTH無改善者3例.本組患者本術前的甲狀徬腺激素值為860～2830 ng/L.行Ⅱ、Ⅲ、Ⅳ及Ⅵ區淋巴結清掃3例,Ⅱ～Ⅵ區、Ⅱ～Ⅶ區和Ⅲ～Ⅶ區清掃各1例,對術後缺損器官行一期脩複.5例患者行預防性氣管切開.結果 病理結果顯示6例患者均有上消化呼吸道侵犯,其中單純氣管食管侵犯者4例,氣管、食管、喉和下嚥均受侵者1例,單純喉內侵犯1例.2例伴Ⅳ及Ⅶ區淋巴結轉移.本次手術後所有甲狀徬腺激素均于術後2h內恢複正常,高鈣血癥均于術後24h內消失.4例患者隨診11 ～40箇月PTH和血鈣均在正常範圍,另2例分彆于術後8箇月和11箇月再次跼部複髮.術後併髮食管瘺和淋巴管瘺各1例,均于保守治療後愈閤.6例患者齣院時均拔管.1例患者併髮胸骨愈閤不良.結論 跼部複髮併侵犯上消化呼吸道的甲狀徬腺癌可穫得較好的手術效果,術前準確定位和術中甲狀徬腺激素鑑測是保證手術成功的關鍵.
목적 탐토침범상소화호흡도복발성갑상방선암적술후복발원인급재수술료효.방법 회고총결6례반상소화호흡도침범적갑상방선암환자수차수술방법、술후복발부위、복발간격시간,본차수술방법급기혈개화갑상방선격소적수평적동태개변.6례환자지전적수술차수분별위4차자2례,2차、3차、5차화7차자각1례,상차수술후혈개급PTH무개선자3례.본조환자본술전적갑상방선격소치위860～2830 ng/L.행Ⅱ、Ⅲ、Ⅳ급Ⅵ구림파결청소3례,Ⅱ～Ⅵ구、Ⅱ～Ⅶ구화Ⅲ～Ⅶ구청소각1례,대술후결손기관행일기수복.5례환자행예방성기관절개.결과 병리결과현시6례환자균유상소화호흡도침범,기중단순기관식관침범자4례,기관、식관、후화하인균수침자1례,단순후내침범1례.2례반Ⅳ급Ⅶ구림파결전이.본차수술후소유갑상방선격소균우술후2h내회복정상,고개혈증균우술후24h내소실.4례환자수진11 ～40개월PTH화혈개균재정상범위,령2례분별우술후8개월화11개월재차국부복발.술후병발식관루화림파관루각1례,균우보수치료후유합.6례환자출원시균발관.1례환자병발흉골유합불량.결론 국부복발병침범상소화호흡도적갑상방선암가획득교호적수술효과,술전준학정위화술중갑상방선격소감측시보증수술성공적관건.
Objective To evaluate the factors contributed to the recurrence of parathyroid carcinoma with the invasion of the upper aerodigestive tract and the outcomes of reoperation.Methods Six cases reviewed,in which the age ranged from 32 to 79 years old.The initial diagnoses and surgical procedures,the sites and surgical treatment of the recurrent disease,and the chemical markers,such as parathyroid hormone (PTH) and serum calcium,were retrospectively studied.The preoperative PTH levels ranged from 860 to 2830 ng/L.In 4 patients the recurrence diseases were founded in the tracheoesophageal groove,of them one with invasion of the larynx only and one with invasion of the larynx and pharynx in addition to the trachea and esophagus involvement.Selective neck dissection for level Ⅱ,Ⅲ,Ⅳ and Ⅵ was taken in all cases in addition to the removal of the local recurrent diseases.Recurrent laryngeal nerves were so badly embeded in tumor tissue that they were intentionally resected in 4 patients although they were functionally normal before operation.Prophylactic tracheostomy was carried out in 5 cases.Results PTH level dropped more than 70％ of that prior the operation at 10 min after the removal of the tumor-bearing tissues and to normal range within the first 2 hours postoperatively,and hypocalcemia disappeared in 2 days postoperatively.All cases experienced significant improvement in sympotoms and signs in the first three days postoperatively.PTH and serum calcium levels were within normal range in 4 cases during the follow-up of 11 to 40 months,while hyperparathyroidism was encountered 8 and 11 months postoperatively in other 2 cases,respectively.Esophageal fistula,chylous fistula and dehiscence of sternotomy developed in 3 cases separately.Of 5 patients with tracheostomy,the tracheostomy tubes were removed two weeks in 4 cases and six weeks in the other one after operation.Conclusions Recurrent parathyroid carcinoma even with invasion of the upper aerodigestive tract still has promising surgical outcomes.Both the pricise localization of the recurrent diseases and the intraoperative PTH assay are importance to the successful treatment of these diseases.
