Xu Jian, Yang Rong-ning, Zeng Xian-jie, Li Shu-lan, Yang Jian-bo, Mo Li-gen
Department of Head and Neck Surgery, Guangxi Cancer Hospital, Nanning 530021, China.
Zhonghua Zhong Liu Za Zhi. 2003 Sep;25(5):501-3.
To investigate the management and prognosis of thyroid well-differentiated carcinoma invading the upper aerodigestive tract.
A retrospective analysis of the management was performed done 62 patients with thyroid well-differentiated carcinoma invading the upper aerodigestive tract. The main method of surgery was shaving excision, and the other means including partial thyrochondrectomy, total laryngectomy, sleeve tracheal resection, sternocleidomastoid myoperiosteal flap and myodermal flap reconstruction, or simply palliative excision. Some patients received postoperative radioactive isotope therapy and radiotherapy. All patients were followed-up for 2 to 15 years with an average of 6.5 years.
The best curative effect was proved in the patients with local invasion, with the lumen uninvolved and their locoregional control rate was 100.0% (17/17). And the second choice was in patients with more extensive involvement of the upper aerodigestive tract structures. For them, extensive surgical management was done attempting to remove all gross disease followed by reconstruction, their locoregional control rate was 87.5% (7/8). And the third place was designated to patients with local invasion for which shaving excision was performed even though minor residual disease was left, their locoregional control rate was 55.6% (5/9). The poorest result went to simple palliative excision. For 17 patients with minor residual tumor, the locoregional control rate of those who were given postoperative radioactive isotope therapy was significantly higher than those without.
According to the limits and degree of invasion in the upper aerodigestive tract by thyroid well-differentiated carcinoma, different ways of surgery is indicated. For patients with residual disease, radioactive isotope therapy should be used to improve the result and life quality. Advanced lesions should be given postoperative radio therapy.
探讨甲状腺高分化癌侵犯上呼吸道消化道的治疗及预后情况。
对62例甲状腺高分化癌侵犯上呼吸道消化道患者的治疗情况进行回顾性分析。主要手术方式为削除术，其他方式包括部分甲状软骨切除术、全喉切除术、袖状气管切除术、胸锁乳突肌肌骨膜瓣和肌皮瓣重建术，或单纯姑息性切除术。部分患者术后接受放射性同位素治疗和放疗。所有患者随访2至15年，平均6.5年。
局部侵犯且管腔未受累的患者疗效最佳，其局部区域控制率为100.0%（17/17）。其次是上呼吸道消化道结构受累范围更广的患者。对于他们，进行广泛手术治疗试图切除所有肉眼可见病灶并随后进行重建，其局部区域控制率为87.5%（7/8）。排在第三位的是虽行削除术但仍有少量残留病灶的局部侵犯患者，其局部区域控制率为55.6%（5/9）。单纯姑息性切除术效果最差。对于17例有少量残留肿瘤的患者，术后接受放射性同位素治疗者的局部区域控制率显著高于未接受者。
根据甲状腺高分化癌对上呼吸道消化道的侵犯范围和程度，应采取不同的手术方式。对于有残留病灶的患者，应采用放射性同位素治疗以改善治疗效果和生活质量。晚期病变患者术后应给予放疗。
