Musholt T J, Musholt P B, Behrend M, Raab R, Scheumann G F, Klempnauer J
Department of Visceral and Transplantation Surgery, Hannover University Medical School, Germany.
Surgery. 1999 Dec;126(6):1078-87; discussion 1087-8. doi: 10.1067/msy.2099.102267.
Although differentiated carcinoma of the thyroid gland is a relatively benign tumor, up to 20% of patients are endangered by potentially fatal complications resulting from infiltrating tumor growth into the upper aerodigestive tract.
This study included 33 patients who underwent 34 tracheal or laryngotracheal procedures for invasive differentiated thyroid carcinoma under the direction of a single surgeon (G.F.W.S.). From 1990 to 1994, radical tumor extirpation was performed by "window" resection, and from 1995 to 1998, radical surgery consisted of either circumferential sleeve resection or laryngotracheal "step" resection--a novel method of reconstruction in cases of unilateral tumor infiltration into the larynx and trachea. Resection was limited to laminar ablation in 17 cases. The mean follow-up of 16 patients who survived was 42.5 months (range, 2 months to 8.9 years).
Procedures resulting in primary end-to-end anastomosis of the upper airways were associated with lower perioperative morbidity and improved recurrence-free survival when compared with "window" resections with muscle flap reconstruction. In cases of superficial tracheal tumor infiltration, laminar ablations were sufficient for local tumor control.
Radical eradication of differentiated thyroid carcinoma infiltrating the upper airways followed by radioiodine application should be considered the treatment of choice. Laryngotracheal "step" resection allows tumor extirpation with preservation of neural and muscular structures of the larynx.
尽管甲状腺分化癌是一种相对良性的肿瘤，但高达20%的患者会因肿瘤浸润性生长至上呼吸道而面临潜在的致命并发症风险。
本研究纳入了33例患者，他们在同一位外科医生（G.F.W.S.）的指导下接受了34次针对侵袭性分化型甲状腺癌的气管或喉气管手术。1990年至1994年，通过“开窗”切除术进行根治性肿瘤切除，1995年至1998年，根治性手术包括环形袖状切除术或喉气管“阶梯”切除术——这是一种针对单侧肿瘤浸润至喉和气管病例的新型重建方法。17例患者的切除仅限于椎板消融。16例存活患者的平均随访时间为42.5个月（范围为2个月至8.9年）。
与采用肌瓣重建的“开窗”切除术相比，实现上呼吸道一期端端吻合的手术围手术期发病率更低，无复发生存率更高。在气管浅表肿瘤浸润的病例中，椎板消融足以实现局部肿瘤控制。
对于浸润至上呼吸道的分化型甲状腺癌，应考虑首选根治性切除并随后应用放射性碘进行治疗。喉气管“阶梯”切除术能够在保留喉神经和肌肉结构的情况下切除肿瘤。
