CAJ | 학술논문

目的：探讨累及喉、气管的分化型甲状腺癌的外科处理。方法对29例伴有喉、气管受累的分化型甲状腺癌患者行一期肿瘤切除。其中单纯喉受侵6例，喉、气管受侵3例，气管受侵16例，喉、气管受侵同时伴有带状肌及皮肤受侵4例；I型5例、II型4例、III型9例、IV型11例。所有患者均行甲状腺全切除术，喉、气管受侵者9例行肿瘤气管壁削除术（ I、II型），15例分别行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、气管窗状切除造瘘术，3例行全喉切除术，2例部分喉切除术；4例胸大肌肌皮瓣修复皮肤软组织缺损。结果29例中乳头状腺癌25例，滤泡状腺癌4例；术后随访1～8年，就诊时伴有肺转移的3例术后均行内照射，肺转移灶控制2例，进展1例，带瘤生存；3例复发，2例气管壁复发再手术，1例颈部淋巴结复发放弃治疗术后40个月死亡。随访满3年25例，生存25例；随访满5年14例，生存13例。结论分化型甲状腺癌侵犯喉、气管时，应争取手术切除肿瘤组织，切勿放弃手术。应尽可能切除受累器官，这不仅可消除或缓解由出血及梗阻引起的窒息，且使患者有治疗的机会，同时通过皮瓣修复、气管端端吻合等技术重建喉、气管功能，以提高患者的生存质量。术后行规范的内分泌治疗、核医学治疗可改善患者预后。
목적：탐토루급후、기관적분화형갑상선암적외과처리。방법대29례반유후、기관수루적분화형갑상선암환자행일기종류절제。기중단순후수침6례，후、기관수침3례，기관수침16례，후、기관수침동시반유대상기급피부수침4례；I형5례、II형4례、III형9례、IV형11례。소유환자균행갑상선전절제술，후、기관수침자9례행종류기관벽삭제술（ I、II형），15례분별행기관창상절제흉쇄유돌기기골막판수복술、기관수상절제단단문합술、기관창상절제조루술，3례행전후절제술，2례부분후절제술；4례흉대기기피판수복피부연조직결손。결과29례중유두상선암25례，려포상선암4례；술후수방1～8년，취진시반유폐전이적3례술후균행내조사，폐전이조공제2례，진전1례，대류생존；3례복발，2례기관벽복발재수술，1례경부림파결복발방기치료술후40개월사망。수방만3년25례，생존25례；수방만5년14례，생존13례。결론분화형갑상선암침범후、기관시，응쟁취수술절제종류조직，절물방기수술。응진가능절제수루기관，저불부가소제혹완해유출혈급경조인기적질식，차사환자유치료적궤회，동시통과피판수복、기관단단문합등기술중건후、기관공능，이제고환자적생존질량。술후행규범적내분비치료、핵의학치료가개선환자예후。
Objective To discuss the surgical treatment of differentiated thyroid carcinoma ( DTC) viola-ting larynx and trachea .Methods 29 patients with DTC violating larynx and trachea received primary tumor re-section.Among them, 6 patients were with larynx violation , 3 patients with larynx and trachea violation , 16 pa-tients with trachea violation , and 4 patients with anterior strap muscles and skin violation .In addition, 5 patients were type I , 4 patients type II , 9 patients type III , and 11 patients type IV .All patients accepted the total thy-roidectomy.For patients with larynx and trachea violations , 9 received the slashing tracheal surgery ( type I and II) , 15 patients received the window resection and sternocleidomastoid muscle periosteal flap reconstruction , sleeve resection and anastomosis reconstruction , and window resection and gastrostomy .3 patients received total laryngectomy , 2 patients received partial laryngectomy and 4 patients with skin invasion received the reconstruc-tion with pectoralis major muscle flap .Results For these patients , 25 patients were with papillary adenocarcino-ma, and 4 patients with follicular carcinoma .All patients were followed up for 1 to 8 years.3 cases suffered from recurrence, 2 cases with tracheal recurrence received reoperation .3 cases with lung metastasis received the I 131 therapy, among whom 2 cases achieved the local control of lung tumor and the other one survived with tumor .1 patient died of the neck lymph nodes recurrence .25 patients survived over 3 years.13 patients survived over 5 years.Conclusions For patients with DTC with larynx and trachea violation , we should try our best to eliminate the tumor tissues.For the organs invaded by tumors , if possibly, elimination is also needed .This will eliminate or release the suffocation resulted from bleeding or obstruction .In addition , the function of larynx and trachea can be reconstructed and the life quality of these patients can be improved through the flap reconstruction and trachea anastomosis.Standard endocrine therapy and nuclear medicine therapy contribute to the prognosis improvement .